Volunteer - Fundraising event, fundraising campaign, administrative support

General Information

Name*

First name*

Date of birth

Address*

Apt.

City*

Postal code*

Telephone*

Home

Telephone

Work

Telephone

other

Email*

Fax

Occupation

If retired, previous occupation

Person to contact in case of an emergency

Name

First Name

Telephone

Languages

French

Spoken
Written

English

Spoken
Written

Other languages, please specify:

Your situation

Are you...

A parent or close relative of a child who has cancer?

Yes
No

If so, when was the child diagnosed with cancer?

A parent or close relative of a child in remission?

Yes
No

If so, since when has the child been in remission?

A parent or close relative of a child who died of cancer?

Yes
No

If so, when did the child pass away?

Types of volunteering

Check mark the types of volunteering that interest you

Logistical support during fundraising events or fundraising campaigns
Administrative support (filing, preparation, tidying, mailings, phone calls, etc.)

Other (please specify):

Availability

Monday

Before noon
Afternoon
Evening

Tuesday

Before noon
Afternoon
Evening

Wednesday

Before noon
Afternoon
Evening

Thursday

Before noon
Afternoon
Evening

Friday

Before noon
Afternoon
Evening

Saturday

Before noon
Afternoon
Evening

Sunday

Before noon
Afternoon
Evening

Are there certain times of the year when you are unavailable?

Leucan and you

Are you a member of Leucan?

Yes
no

Are you or have you ever been a volunteer for Leucan?

Yes
No

If yes, for how long and in what type of activity?

What do you know about Leucan?

Have you successfully attended a course or had some training that may be useful in your work as a volunteer at Leucan? If so, please briefly describe (ex. professional or volunteer training).

Are you involved in activities outside of the home, work, or school? If so, what are these activities?

If you had to describe yourself, what would you say?

Is there something else you would like us to know about you?

Date