The time is now to defeat ALS!

*Note: If you have ever registered as a fundraiser, volunteered, or made an online donation to our chapter, please log in with your username and password before completing this form.

1.

Please enter your contact information below:

If you have previously registered, please login here to prepopulate your information.

*

Name:

First Required	Middle Required	Last Required	Suffix

*

Email: Required

Street 1:

Street 2:

City/State/ZIP:

City	State	ZIP

*

Phone Number: Required

Employer:

Gender:

*

Date of Birth: Required

Date of Birth:

Yes, I would like to receive e-mail from The ALS Association Evergreen Chapter

Yes, I would like to receive postal mail from The ALS Association Evergreen Chapter

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Please enter a user name and password for logging in when you return. You can use this password to update your information or receive personalized content.

*	User Name: Required	5 to 60 characters
*	Password: Required	12 to 99 characters
*	Repeat Password: Required

*2.

Question - Required - What is the best way for us to contact you? Email
Phone
Text
Facebook

3.

Question - Not Required - How would you like to help? (you may choose more than one)
Please make between 1 and 3 selections from the choices below.

	Walk Committee Volunteer
	Walk Day Volunteer
	Office Volunteer (Agoura Hills Office)

*4.

Question - Required - Please select your availability for the day of the event.
Please make between 1 and 3 selections from the choices below.

	Morning (3-4 hours)
	Afternoon (3-4 hours)
	Full Day (about 7 hours)

5.

Question - Not Required - If you are interested in serving on one of our Walk Committees, please indicate your area of interest: (you may choose more than one)

	Corporate Sponsor Committee
	Corporate Team Committee
	Family Team Committee
	Logistics Committee
	Volunteer Committee
	Food & Beverage Committee

*6.

Question - Required - Please select the answer that best describes your relationship to ALS.

*7.

Question - Required - What size t-shirt do you wear? Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
Adult 3XL

8.

Question - Not Required - Are you interested in creating a fundraising team for this event? Yes
No

9.

Question - Not Required - Please list any languages you are proficient in, other than English.

10.

Question - Not Required - How did you hear about our Walk Volunteer opportunities?

11.

Question - Not Required - Have previous volunteer experience? Let us know!

Please feel free to reach out to Jessica Partida at jpartida@alsagoldenwest.org with any questions/ concerns.

2019 Ventura/ Santa Barbara County Walk Volunteer Form

*Note: If you have ever registered as a fundraiser, volunteered, or made an online donation to our chapter, please log in with your username and password before completing this form.

Thank You to Our National Sponsors

Our Local Sponsors

2019 Ventura/ Santa Barbara County Walk Volunteer Form

*Note: If you have ever registered as a fundraiser, volunteered, or made an online donation to our chapter, please log in with your username and password before completing this form.

Thank You to Our National Sponsors

Our Local Presenting Sponsor

Our Local Sponsors