American Liver Foundation: Survey - New England Volunteer Form

New England Volunteer Form

About you

Name:

First Required	Last Required

Email: Required

Street 1: Required

Street 2:

City/State/ZIP:

City Required	State Required	ZIP Required

Country:

Phone Number: Required

Employer:

Occupation:

Gender: Required

Date of Birth: Required

Date of Birth:

Yes, I would like to receive e-mail from American Liver Foundation

Remember me. What's this?

*2.

Question - Required - Emergency contact name:

*3.

Question - Required - Emergency contact phone number:

*4.

Question - Required - How many years have you volunteered with ALF?

*5.

Question - Required - Volunteering at specific events allows you to be eligible for a volunteer T-shirt. What is your T-shirt size? Small
Medium
Large
X-Large
XX-Large

*6.

Question - Required - Please see below for a listing of our upcoming volunteer opportunities. Please be aware that although your selections will place you on event specific emails going forward, they will not serve as confirmations of your attendance at these events.
Please make between 1 and 11 selections from the choices below.

	Chilly Half Marathon - November 11, 2012
	Run For Research: Love Your Liver Long Run - Saturday, February 9, 2013
	Run For Research: March Long Run - Saturday, March 23, 2013
	Run For Research: Marathon Weekend Brunch - Sunday, April 14, 2013
	Run For Research: Marathon Day - Monday, April 15, 2013
	Liver Life Walk MA - TBD, 2013
	Liver Life Walk RI - TBD, 2013
	Liver Life Walk ME - TBD, 2013
	Flavors of Boston - TBD, 2013
	Office Volunteer - M-F, 9:00am-5:00pm
	Additional events

*7.

Question - Required - Do you have any physical or health restrictions that would hinder your ability to perform certain volunteer responsibilities?

*8.

Question - Required - How are you connected to the cause?
Please make between 1 and 3 selections from the choices below.

	I have liver disease
	A family member has liver disease
	A friend has liver disease
	ALF is a good charity to volunteer for
	I work for a company that supports ALF
	Other

*9.

Question - Required - By filling out this form, I am acknowledging that I am an active volunteer for the American Liver Foundation (ALF) and would like to be contacted regarding all ALF volunteer opportunities. I acknowledge and assume all risks associated with this event. I waive and release the American Liver Foundation, its employees, chapters, directors, officers, volunteers, agents, successors and assigns, from any and all claims, liabilities or causes of action, including without limitation, death, bodily injury, property damage, or any other loss, damage or any inconvenience whatsoever, arising from my participation in this event. Further, I grant full permission to the American Liver Foundation to use photographs, videos and other types of recordings of me in advertising, trade or any commercial purpose in legitimate accounts and promotions of this event. I waive the right to inspect versions of my image used for publication or the written copy used in connection with the images. I agree.