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Home » Volunteer Application

Volunteer Application

Name*
First Last
Address
Street Address Address Line 2 City State ZIP Code
Home Phone*
Work Phone
Cell Phone
Email
Check all the apply*
- Student
- Employed
- Retired
- Homemaker
- Other
If other, explain
Employer
Employer Location (City)
Postion or Title
Please indicate any special skills (Bilingual, computers, etc.)
What days are you available (check all that apply)*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
- Sunday
Please indicate specific times you are available*
Check all areas that interests you*
- Fundraising events
- Working with computers
- Office work
- Running errands
- Patient advocacy
- Breast health education
- Making mammogram reminder calls
Emergency Contact
Name*
First Last
Number*
Relationship*
Statement of Understanding
I understand that as a volunteer for Libby's Legacy Breast Cancer Foundation I am representing a non-profit organization. I hereby forever release, discharge and agree to hold harmless and indemnify Libby's Legacy Breast Cancer Foundation, its board of directors, officers, members and agents from all claims, demands, actions, causes of action or liability of any kind whatsoever arising as a result of my performance of volunteer work for Libby's Legacy Breast Cancer Foundation.
**After submitting this form, please allow 1-2 days for processing
Today's date*
MM slash DD slash YYYY

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TAX ID#: 11-371266 Solicitation Registration #: CH25850: A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE 1-800-435-7352 WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.

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