Volunteer Application
* required information
Volunteer Application 
Contact Information
Title:
First Name:*
Last Name:*
Email:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Country:
Phone:*
Company Name:
Job Title:
Gender: Female   Male  
Birth Date:(mm/dd/yyyy)
What other language(s) do you speak?:
Do you wish to be recognized as a breast cancer survivor?:
What do you hope to gain from your Komen volunteer experience?:
What tasks do you prefer to do?:* Copying
Data Entry
Faxing
Filing
Mailing
Phone Work
Reception
No Preference
In which of the following areas do you have computer skills?:* Data Management
Excel
Graphics
PowerPoint
Typing
Web Development
Word
Other
None
In which of the following areas do you have experience and/or interest?:* Community Outreach
Counseling
Event Planning
Finance
Fund Development
Grant Writing
Journalism
Photography
Public Relations
Public Speaking
Research
Teaching
Other
Do you have additional skills that you can contribute to Komen?:
Please list other organizations that you have volunteered for.:
How did you hear about Komen for the Cure?:*
Have you ever volunteered for the Phoenix Affiliate or any other Komen Affiliate? If yes, please list Affiliate and role.:
How often would you like to volunteer?:* Daily
Weekly
Monthly
Race for the Cure
Special Events
Whenever Needed
Comments:
Emergency Contact Name: (We will contact this person in case of an emergency while you are volunteering for Komen.):*
Emergency Contact Relationship:*
Emergency Contact Phone Number:*
Do you need any special accomodations in order to volunteer?:*
If yes, please specify your needs or challenges.:
I agree with the terms of the waiver. Please note: If you are under 18, a parent/guardian must accept this waiver.:* Yes

Waiver

I hereby verify that to my knowledge the above information is accurate. I recognize that as a Komen volunteer, I am a representative of the Phoenix Affiliate of the Susan G. Komen for the Cure Breast Cancer Foundation and I will follow the guidelines set forth by the said organization. I wish to volunteer for the Phoenix Affiliate of the Susan G. Komen for the Cure Breast Cancer Foundation, Inc. (the "Komen Affiliate"). I understand that the nature of volunteer activities that I may perform in my capacity as a volunteer may involve physical activity, contact with unidentified and/or unfamiliar persons, or other potential risk of bodily injury or damage to property. Knowing this and in consideration of being allowed to volunteer, I HEREBY ASSUME FULL AND COMPLETE RESPONSIBILITY FOR ANY PERSONAL INJURY AND/OR PROPERTY DAMAGE THAT I SUSTAIN OR CAUSE DURING MY PARTICIPATION AS A VOLUNTEER. IN ADDITION, I HEREBY RELEASE, HOLD HARMLESS AND COVENANT NOT TO FILE SUIT AGAINST THE KOMEN AFFILIATE, THE SUSAN G. KOMEN for the Cure BREAST CANCER FOUNDATION, INC. (THE "FOUNDATION" “ORGANIZATION”) AND ANY OF THEIR EMPLOYEES, VOLUNTEERS, PARTNERS, AGENTS, SPONSORS, BOARD MEMBERS AND SUCCESSORS FROM ANY AND ALL LOSS, LIABILITY OR CLAIMS I MAY HAVE ARISING OUT OF MY SERVICE AS A VOLUNTEER. I understand that as a volunteer, I may become privy to confidential information about the Komen Affiliate or the Foundation Organization. I agree to maintain the confidentiality of any information marked "confidential" as well as any information about the Komen Affiliate's or the Foundation's Organization’s internal procedures, business operations, personnel information and the like that is not otherwise publicly disclosed by the Komen Affiliate of the Foundation. I will not use any confidential information in any manner that would be detrimental to the Komen Affiliate or the Foundation Organization, and I will avoid any actions that might impair the reputation of the Komen Affiliate or the Foundation Organization

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