Volunteer Signup Form

First name: *
Last name: *
Address:
Unit/Suite/Apt:
Street No.: *
Street Name: *
City:*
Province/Territory:*
Postal code:*
Telephone #:*
Work #:
Cell #:
Preference:              Home Office Cell
Email:*
How did you learn about volunteering with our Organization? *
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PHAN Publication/ brochure PHAN Website
PHAN Event    
Another agency (Please specify):
Other (Please specify):
Why would you like to volunteer with us? *

 
Please Check Mark Areas of Interest in Volunteering:
Office Administration Community Education/Outreach - Youth
Community Education/Outreach - African Diaspora Fundraising
Community Education/Outreach - Harm Reduction/IDU Graphic Design
Community Education/Outreach - LGBT PHA (People living with HIV/AIDS) Support
Community Education/Outreach - MSM Research
Community Education/Outreach - Women Special Events
Availability (Please specify availability between 8 am - 10 pm for each day):
Monday Friday:
Tuesday: Saturday:
Wednesday: Sunday:
Thursday:    
Peel HIV/AIDS Network requires a time commitment of 1 year. Are you able to fill this requirement?  Yes No
 

Contact Information

Please only list information where it's OK for us to contact you
First name: *
Last name: *
Email:*
 
Declaration and Authorization for Collection of Personal Information:
By checking this box. I hereby declare that the above information is true and complete to the best of my knowledge. I understand that a false statement may disqualify me from further consideration as a volunteer or result in dismissal. I authorize the Peel HIV/AIDS Network to collect personal information appropriate to the position applied for concerning my academic background and employment / volunteering history, and to verify the character references I have supplied.