2015 Conference Volunteer Registration

Name

First NameLast Name

Date of birth

Date

E-mail

Phone Number

Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How did you hear about Intouch Foundation? (You may select more than one)

When are you available to volunteer? (You may select more than one)

Why do you want to become a volunteer with Intouch Foundation?

What skills and attributes would you bring to the InTouch Foundation?

Do you have any health conditions that may affect volunteering?

Do you drive?

Do you have a minibus licence (D1)?

Do you have any criminal conviction/s? (A DBS check will need to be done if you cannot provide a CRB) *Having a criminal conviction does not necessary mean you cannot volunteer

Agreement

1. Not to disclose any information about InTouch Foundation to any third person or agency without permission from the CEO or Management Committee.
2. Not to use any contacts or information gained through work done for the InTouch Foundation for personal gain.
3. I will not bring InTouch Foundation into disrepute by my actions.

Photo/Video Authorisation:
I authorise you to take photographs/video of me and for those images to be used by InTouch Foundation for the purpose of printed, digital, video or other mediums, for the purposes of promotion and publicity for InTouch. Those images shall be the property of InTouch Foundation for any and all use.

Seated position

Date

Digital signature

Thank you for taking time to fill this form out. Any information given will be treated confidentially.

After you click Submit, you will receive an email confirmation.