Volunteer Profile Registration Step 1 of 3 33% Your information As a volunteer, you are an important member of our staff and act as a representative of our organization to the community at large. Please ask questions, have fun and thank you for donating your time and talents to make an even greater impact in central Ohio. Name* First Last is an unpaid volunteer at Cancer Support Community Central Ohio (formerly The Wellness Community—Central Ohio).Date of birth* Date Format: MM slash DD slash YYYY Address* Address Line 1 Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Home/Cell Phone*Work Phone In case of emergencyName* First Last Relationship*Phone* Additional informationHow did you hear about us? Newsletter Friend Other Would you be interested in helping with the following?Telephone/ReceptionCommunity OutreachCouncil For HopeNewsletter DistributionComputer/Data EntryGrant Writing/ResearchBulk MailingsSpecial EventsWebsiteAssist Program DirectorAvailability* Monday Tuesday Wednesday Thursday Friday Weekends (as needed) Special event(s) If special events was selected above, which event(s)?FrequencyWeeklyMonthlyWhat organizations have you volunteered in the past and what were your duties?Please tell us about your skills/talents that you have and additional information you would like us to know.CONFIDENTIALITY I understand that any information acquired during my duties as a volunteer concerning participants, staff, board of directors or other volunteers is to remain confidential and not to be discussed outside of the organization. If any problems arise, I will contact a supervisor. I further agree to: • Perform the duties of this position to the best of my abilities • Volunteer per the schedule noted above • Meet time requirements or provide adequate notice so a replacement may be found Enter electronic signature* Checking this box confirms your digital signature
