Survey - Sign Up to Volunteer - American Lung Association

Please provide the following information so we can learn a bit more about you:


	Title:
*	First Name: Required
*	Last Name: Required
*	Email: Required
*	Street 1: Required
	Street 2:
*	City: Required
*	State / Province: Required
*	ZIP / Postal Code: Required
*	Phone Number: Required
	Employer:
	Occupation:
*	Gender: Required
	If you respond and have not already registered, you will receive periodic updates and communications from American Lung Association.

*

Question - Required - What is the best time of day to reach you Monday - Friday? Morning
Afternoon
Evening

*

Question - Required - What is your preferred method of contact? Phone
Email

Question - Not Required - Do you have a lung disease?

Question - Not Required - If yes, please specify:

*

Question - Required - Are you currently a student? No
High School
College
Graduate School

*

Question - Required - How much time would you like to spend volunteering? (e.g., 1 hour per month or 3 hours per year)

*

Question - Required - Please check all areas of interest for the purposes of volunteering:

	Administrative Support
	Athletic and Fundraising Events
	Advocacy (public policy support for lung health and healthy air)
	Lung Health Education (including asthma, COPD and lung cancer)
	Tobacco Use Prevention and Cessation (including Freedom From Smoking)
	Medical Expertise
	Professional Skills
	Other

Question - Not Required - If other, please specify:

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

Question - Not Required - Feel free to share any professional skills you have:

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