Survey - Georgia Walk Volunteer Survey - The ALS Association Georgia Chapter

Please enter your contact information below:

*

Name:

Title	First Required	Middle Required	Last Required	Suffix

*

Email: Required

Street 1:

City/State/ZIP:

City	State	ZIP

*

Phone Number: Required

If you respond and have not already registered, you will receive periodic updates and communications from The ALS Association Georgia Chapter.

Question - Not Required - How should we contact you?

Email

Phone

Question - Not Required - At which Walk location would you like to volunteer?

Question - Not Required - How would you like to help?
Please make up to 3 selections from the choices below.

	Pre-Walk Volunteer in the office Monday-Friday from 9am-5pm
	Walk Day Volunteer
	Post-Walk Volunteer in the office Monday-Friday from 9am-5pm

Question - Not Required - If you are interested in becoming a Walk Day Volunteer, please indicate your area of interest:

Question - Not Required - Are you over the age of 16?

	Yes
	No

Question - Not Required - Do you know someone with ALS?

(Maximum response 255 chars, approx. 5 rows of text)