Volunteer Sign-up Form
The American Parkinson Disease Association (APDA) is a nonprofit organization dedicated to fighting Parkinson’s disease (PD) by providing the support, education, research, and community that helps everyone impacted by PD live life to the fullest. Through a nationwide grassroots network of Chapters and Information & Referral (I&R) Centers, APDA works tirelessly to raise public awareness of this chronic neurologic movement disorder and deliver outstanding patient services, resources, and educational and wellness programs to the approximately one million people living with PD in the United States and their care partners and families. Envisioning a world without PD, APDA’s national research program and Centers for Advanced Research aim to provide better treatments and unlock the mysteries of the disease. APDA is also committed to advancing public policy solutions that improve lives and move us toward a cure. Founded in 1961, APDA has raised and invested more than $338 million in its efforts to support the PD community. We encourage the participation of volunteers who support our mission and are willing to contribute. The information provided through this form will be confidential and help us determine your most satisfying and appropriate volunteer opportunity.
Full Name
First Name
Last Name
E-mail
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Preferred method of contact:
Email
Phone
Where did you hear about us?
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Employee Referral
External Referral
Partner
Public Relations
Seminar - Internal
Seminar - Partner
Trade Show
Web
Word of mouth
Other
Birth Date (if under 18, a parent or guardian must sign and submit this application)
Have you ever been convicted of a misdemeanor or felony? If yes, please explain:
*
Please include any of the following skills, or if you have other skills that you want to share, please include them under other (check all that apply):
Fundraising
Database Resource Research
Logisitcs
Education/Outreach
Event Planning
Board of Directors/Committees
Tell us about your past volunteer experience and why you would like to volunteer with APDA Florida.
What is your availability?
Which counties would you be interested in volunteering for?
Today's date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date available to begin volunteering
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Parental/Guardian ConsentIf the volunteer is under 18 years of age, a parent or guardian must fill out the following information.
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Do you agree and consent to the applicant volunteering for our organization?
Yes
NO
We look forward to connecting!
By submitting and signing this application, you agree to the Release and Waiver of Liability on the next page.
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