VOLUNTEER ENROLLMENT FORM

Instructions: Please complete this form, then print it and mail or fax to: Alzheimer's Services, 3772 North Blvd., Baton Rouge, LA 70806, fax: 225-387-3664.

Thank you for your interest in Alzheimer's Services.

Name:
Organization (if applicable):
Address:
City: State: Zip:
Phone: Daytime: Evening:
Email:

I. SKILLS AND INTEREST
A. Education background:
B. Current occupation:
C. Previous volunteer experience:

II. PREFERENCES IN VOLUNTEERING
A. Is there a particular type of volunteer work in which you are interested? (Please check all that apply)
Working directly with a staff person as an assistant
Helping around the office in general administrative duties
Doing research, training or an individual project
Working occasionally on group projects
Public speaking
No preference
Other:

B. Current volunteer opportunities:

MEMORIES IN THE MAKING LUNCHEON (May 2008)
Planning Committee
Host a Table
Registration
Set Up/Clean Up

A WALK/RUN TO REMEMBER (October 18, 2008)
Logistics Committee ( Site Setup Food/Beverage Children's Village & Entertainment Race Prizes Volunteer Coordination)
Public Relations Committee
Individual/Team Recruitment & Registration Committee
Corporate Sponsors Committee
I'd like to form a team to walk and/or run
I'd like to volunteer the day of the event

C. EDUCATION AND PROGRAMS
Health Fairs
Caregiver Network Facilitator
Speaker's Bureau
Caregiver Social (Spring & Fall)
Annual Conference Planning Committee (Spring)
Lunch 'N Learn Programs Registration & Set Up (Last two Wednesdays of the month, 12 PM - 1 PM)
Alzheimer's Awareness Month Activities (November)
Outreach (deliver materials to nursing homes, physician offices, etc.)
Alzheimer's Respite Center (assist participants with activities, meals, etc.)

D. ADVOCACY
Write Letters Make Phone Calls to recruit other
Public Policy Committee advocates
Meet with Legislators

E. GENERAL
Answer telephone Data Entry
Office help, staff assistance Bulk Mailing

III. AVAILABILITY
A. At what times are you interested in volunteering?
I am flexible
Prefer weekdays in the AM PM
Prefer weekends
Other

IV. HOW DID YOU HEAR ABOUT US?
Saw job description Saw/heard advertisement
Referred by friend/volunteer Volunteer Baton Rouge!
Agency/School/Organization
Other