MBCN_logo_2010kerned

 
Volunteer Application

 

Contact Information

First Name

Last Name

Street Address

City State Zip

Home Phone

Cell Phone

Work Phone

E-Mail Address

 

How have you been affected by metastatic breast cancer?

diagnosed with Stage IV breast cancer

Year diagnosed:

diagnosed with earlier stage of breast cancer

Year diagnosed:

family member or friend has metastatic breast cancer

in memory of family or friend

general interest in metastatic breast cancer

 

How did you learn about MBCN

 

website attended conference MBCN email friend message board blog
other

 

Comments:

 

 

Interests

Tell us in which areas you are interested in volunteering

 

MBCN Annual Conference Planning

MBCN Outreach Project (contact Hospitals, Oncology Groups, Cancer Centers, Support Groups, other bc orgs)

MBC Awareness Day Campaign

Facebook, Twitter or Online message board posting

Attend other bc org conferences to staff MBCN table and distribute materials, talk to participants

Fundraising

Website updates

Other:

 

 

 

Previous Volunteer Experience /Comments

Summarize your previous volunteer experience. Add any comments.

 

Agreement and Signature

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

 

Name

Date

 

Our Policy

It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

 

Thank you for completing this application form and for your interest in volunteering with us.

 

MBCN Volunteer Committee