Name *                 

Street Address *    

City *                    

State *                  AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code *            

Home Phone *       

Work Phone           

Cell Phone             

Email Address *     

Availability

During which hours are you available for volunteer assignments?

 Weekday mornings Weekday afternoons Weekday evenings Weekend mornings Weekend afternoons Weekend evenings

Interests

Tell us in which areas you are interested in volunteering?

CACT Volunteers

 Grant-Writing Corporate Sponsorships Local Organizations Marketing/Promotions

Stepping Into Health Volunteers

 Soliciting Other Volunteers Soliciting for Challenge Participants Soliciting for Corporate Sponsorships for this Event Volunteer for Weekly Meetings Volunteer for Finale Program

Special Skills or Qualifications

Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities (including hobbies or sports).