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National Multiple Sclerosis Society

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National Home > Chapters > Central New England > Volunteer Application

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Central New England
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Volunteer Application

Please provide your contact information and areas of interest.

If you have previously registered, please login here to prepopulate your information.

Name:

First Required	Last Required

Email: Required

Street 1: Required

Street 2:

City/State/ZIP:

City Required	State/Province Required	ZIP/Postal Code Required

Phone Number: Required

Employer:

Yes, I would like to receive important email updates - including event announcements - from the National MS Society.

Yes, I would like to receive important postal mail updates - including event announcements - from the National MS Society.

Remember me. What's this?

Please enter a username and password that you can use when you return. You can use this password to update your information or receive personalized content.

*	Username: Required	5 to 60 characters
*	Password: Required	5 to 20 characters
*	Confirm Password: Required

Question - Not Required - Occupation:

Question - Not Required - Volunteer Experience:

Question - Required - Have you volunteered for the National MS Society before?

Question - Not Required - If Yes, in what capacity?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - How did you hear about the National MS Society?

(Maximum response 255 chars, approx. 5 rows of text)

References: (please use non-family members)

Question - Required - Reference #1 - Name:

Question - Required - Reference #1 - Phone:

Question - Required - Reference #1 - Relationship:

Question - Required - Reference #1 - Address, including City, State, and ZIP Code

(Maximum response 255 chars, approx. 5 rows of text)

Question - Required - Reference #2 - Name:

Question - Required - Reference #2 - Phone:

Question - Required - Reference #2 - Relationship:

Question - Required - Reference #2 - Address, including City, State, and ZIP Code

(Maximum response 255 chars, approx. 5 rows of text)

Emergency information contact:

Question - Required - Emergency Contact Name:

Question - Required - Emergency Contact - Relationship:

Question - Required - Emergency Contact Phone:

Question - Required - Do you have any special needs or limitations we need to know about?

Question - Not Required - If Yes, please explain:

Question - Required - When are you available as a volunteer? (check all that apply)

	Weekday Mornings
	Weekday Afternoons
	Weekday Evenings
	Weekends
	Multiple Days (including overnight)

Question - Not Required - What types of volunteer activities are of interest to you? (check all that apply)

	Bike Tours
	Clerical
	Contacting Media
	Contacting Sponsors
	Data Entry
	Educational Programs
	Fundraising Coordination
	Exercise (adaptive)
	Health Fair Booths
	Information and Referral
	Legislative/Advocacy
	MS Walks
	Peer Counselor
	Phone Calling (event promotion)
	Phone Calling (thanking donors)
	Planning Committees
	Public Speaking
	Route Safety
	Special Events
	Stuffing Envelopes/Mailings
	Truck Driving
	Vacation Week/Weekends
	Volunteer Recruitment
	Other (please specify)

Question - Not Required - If other, please specify:

Question - Not Required - Do you have training or extensive experience in any of the following areas? (check all that apply)

	Accounting
	Administration
	Advertising/PR
	Audio/Visual Systems
	CPR
	Data Entry
	EMT
	Entertainment/Musician
	Event Coordinating
	First Aid
	Food Service/Catering
	Grant Writing
	Graphic Design
	Group Facilitating
	Ham Radio Communications
	Human Resources
	Internet
	Law Enforcement
	Legal (specify below)
	Massage Therapy
	MD
	Notary Public
	Occupational Therapy
	Photography/Video
	Physical Therapy
	Proof Reading
	Public Broadcasting
	RN
	Social Work
	Teaching
	Therapist/Counseling
	Volunteer Coordination
	Website Design
	Other (please specify)

Question - Not Required - If other, please specify:

Question - Not Required - Please list your computer skills:

	MS Word
	MS Excel
	MS Access
	MS Outlook

Question - Not Required - Please list additional computer experience/skills

(Maximum response 255 chars, approx. 5 rows of text)

Question - Required - To the degree I may be given access to the identity and details of persons with multiple sclerosis and their families, as well as to donors' names and giving history, I will treat this information in strict confidence. I also recognize that the Chapter's staff will provide continuing direction and counsel to me as to the proper use of confidential information.

I agree