IHS Volunteer Interest Form

IHS Volunteer Interest Form

_{Thank you for your interest in volunteering with IHS! Please complete the below form with your contact information so our team can contact you as volunteer opportunities arise.}
Name*

First NameLast Name
Member ID
Phone Number*

Area CodePhone Number
E-mail*
State/Province*
Credentials (select all that apply)*

BC-HISACAAuDMDCCC-ANoneOther
Which of the following best describe you? (Select all that apply)*

Business ownerClinical staffEducatorOther
Why do you want to volunteer with IHS?*
What previous volunteer experience do you have, if any? (Such as volunteering on an IHS committee or with your local chapter.)
What type of volunteer opportunities are you interested in? (i.e. committee service, convention volunteer, leadership opportunities, article reviewer)
The time commitment I am able to give as a volunteer is:*

One-timeOccasionally throughout the yearQuarterlyMonthly
I am interested and have experience in the following topics: (select all that apply)*

Education and clinical careMarketingBusiness practicesManaged CareChapters and/or volunteer leadershipAdvocacy and government relationsTraining new professionalsOther
I am interested in:*

Only in-person volunteer opportunitiesOnly virtual volunteer opportunitiesBoth in-person and virtual volunteer opportunities
Are you planning to attend the IHS Conference in September?

YesNoNot sure
Acknowledgment:

The information contained in this application is true and correct to the best of my knowledge.

By submitting this application, I understand that completion of this application does not obligate IHS to engage me on a voluntary basis. As a volunteer of IHS, I agree to abide by the organization’s policies and procedures. I understand that I may be required to sign a Confidentiality Agreement before engaging in a volunteer role.

Volunteers are vital to IHS achieveing its purpose and mission. Volunteers are welcomed and treated as valued and integral members of IHS.
By checking this box and submitting this form, I agree to the above.*

I agree
Thank you for your volunteerism and interest in serving IHS!
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