Volunteer Form
Full Name
*
First Name
Last Name
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
*
Male
Female
Emergency Contact Information
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Relationship
*
Volunteer Availability
I am available:
*
Week Days
Weekends
Holidays
Days
Evening
Other
Are you?
*
Blind
Visually Impaired
Sighted
If you are sighted have you ever received sighted guide technique training?
*
Yes
No
If you are Blind or Visually Impaired have you received orientation and mobility training?
*
Yes
No
Where would you like to volunteer? You can pick from the list below:
*
Advocacy
Contact
Convention
Events
Fundraising
Gadgets and Gizmos
Membership
Publicity and Media
Parents and Youths
Scholarship
Volunteer Driver
Volunteer Sighted Guide
Assisting as audio/visual tech at in-person meetings and events
Volunteer Reader
Blind Mentor
Submit
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