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
	Advocacy (legislative action and support)
	Asthma Education
	Environmental Health Education
	Medical Expertise
	Professional Skills
	Tobacco Control Education (including Freedom From Smoking facilitator training)
	Athletic and Fundraising Events

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

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