Parkinson's Foundation: Believe in Better

Volunteer Interest Form

1. *required fields

Field Is Required First Name:

Last Name:

Field Is Required Date of Birth:

Field Is Required Street 1:

Street 2:

Field Is Required City/Town:

Field Is Required State / Province:

Field Is Required ZIP / Postal Code:

Field Is Required Email Address:

Field Is Required Phone Number:

Yes, I would like to receive e-mail from Parkinson's Foundation

2. Field Is Required What best describes your connection to Parkinson's disease (PD)?

3. If you selected Other, please specify:

4. Field Is Required Are you involved with the person with Parkinson's care?

5. Please share the year of Parkinson's diagnosis:

6. If you selected Healthcare Professional, please specify:

7. If you selected Other Healthcare/Services Professional, please specify:

8. Field Is Required What volunteer opportunities are you interested in? Please make at least 1 selection from the choices below.

Parkinson's Foundation Ambassador
Volunteering for events
People with Parkinson's Advisory Council
Research Advocates

9. Do you have any special skills you would like to bring to your volunteer work (e.g., community outreach, fundraising, design, etc.)? (Maximum response 255 chars, approx. 5 rows of text)

10. Field Is Required How did you first learn about volunteering with the Parkinson's Foundation?

11. If other, please explain:

12. Field Is Required Are you a veteran?

Yes
No
My loved one with PD is a Veteran

13. Field Is Required Which language would you prefer to hear from us in? *Please note that not all content is available in both languages. If you are interested in receiving Spanish communications, we recommend selecting "both" to stay best informed on the Foundation's work and the latest in PD news.

English
Spanish
Both English and Spanish

14. Field Is Required I agree to the terms and conditions of the Volunteer Waiver.

15. Field Is Required Please type your full name to certify that you have read the waiver at www.parkinson.org/volunteerwaiver and agree to it.