NAACP 5117-B Volunteer Sign-Up Form
Register to volunteer and support community health initiatives.
Personal Information
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
City
*
ZIP Code
*
Preferred Contact Method
*
Email
Phone Call
Text Message
Best Time to Contact
*
Morning 8am–12pm
Afternoon 12pm–5pm
Evening 5pm–8pm
NAACP 5117-B Membership
Are you a current NAACP Branch 5117-B member?
*
Yes, I am an active member
No, I am not a member
I was a member, but my membership has lapsed
Would you like to become a member?
*
Yes, I would like to join
No thank you
I am already an active member
I would like more information first
Volunteer Interests
Volunteer Interest Areas
*
Health Screenings and Clinical Support
Event Setup and Logistics
Youth and Family Zone
Social Determinants and Resource Navigation
Policy and Advocacy Zone
Marketing and Social Media
Photography and Videography
Translation Services (Spanish, Haitian Creole, or Other*)
Outreach and Community Engagement
Administrative and Data Entry
Food and Hospitality
Other
If you selected Other, please describe
Are you available for the NAACP 5117-B Health Equity Summit on September 24, 2026?
*
Yes, I am available
No, I am not available
Maybe, I need to confirm
Monthly volunteer availability
*
1–5 hours per month
5–10 hours per month
10–20 hours per month
20+ hours per month
Event day only
Skills and Experience
Skills and Professional Background
*
Healthcare and Medical
Social Work and Case Management
Education and Teaching
Banking and Finance
Legal
Marketing and Communications
Technology and IT
Event Planning and Coordination
Leadership and Management
Community Organizing
Other
Other Skills or Professional Background
Do you hold any professional licenses or certifications?
*
Yes
No
Please list your licenses or certifications
Have you volunteered with NAACP Branch 5117-B or any other NAACP branch before?
*
Yes
No
Please describe your volunteer experience
Languages
Languages Spoken (other than English)
*
Spanish
Haitian Creole
French
Portuguese
American Sign Language
Other
Other language(s), please list
Emergency Contact
Emergency Contact Full Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Emergency Contact
*
Spouse or Partner
Parent
Sibling
Friend
Other
Agreements and Waiver
Acknowledgement
*
I understand that volunteering with the NAACP Branch 5117-B Health Committee is unpaid and is done of my own free will.
I understand that I will represent the committee with professionalism, respect, and integrity.
I understand that to serve as a committee member, not just a volunteer, I must be an active paying NAACP Branch 5117-B member.
Photo and media permission
*
Yes, I give permission for photos and videos taken of me during NAACP Branch 5117-B events to be used for promotional and educational purposes.
No, I do not give permission for my image to be used.
Agreement signature
*
Agreement date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Questions and Comments
Questions or comments for the Health Committee
Anything else the committee should know
How did you hear about us?
Health Equity Voice Newsletter
QR Code Scan
Facebook, Instagram, or Social Media
Friend or Family Member
NAACP Branch Meeting
Community Event
Flyer
Other
Submit
Submit
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