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Volunteer

Thank you for your interest in volunteering with HCFA NC. The information on this form will allow us to help you find the best volunteer placement. Please ensure that you answer all questions on all tabs as completely as possible. By providing a valid email address and password, you are also creating a login to this site. This login will make it quicker for you to join or renew your membership, make a donation, volunteer with our organization, or even share you personal health care story. Note that after you submit this form, you will be logged in on our site, and any time you return to the site, you may login again by entering your email and password in the form provided near the bottom of every page.

Some of the drop-down boxes allow you to select more than one item. You can do this easily by holding down the "Ctrl" button and clicking on the item in the list. Items marked with an asterisk (*) are required.

Contact Info
Title:
First Name:*
Last Name:*
Billing Address:*
Billing Address:
City:*
State (ex. NC)/Zip:*
Email Address:*
Verify email:*
Password:*
Verify Password:*
Home Phone:*
Work Phone:
Mobile Phone:
Best way(s) to contact you:*
Would you like to join the HCFA NC listserv?*
Yes! No, thank you I am already on the listserv
Skill(s) and Interest(s):*
If you selected bilingual, what language(s) do you speak?
Language(s):
What is your availability for volunteer work? Please type in "Y" or "YES" under the appropriate column/day of week if you can volunteer at that day and time. Leave times/days when you cannot volunteer blank. Note: Most committees meet on evenings or weekends.
yes
How long you would like to volunteer?*
What is your ideal volunteer position with HCFA NC and why?*
What would you like to gain from volunteering with HCFA NC?*
How did you hear about HCFA NC?*
 
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