Volunteer Sign-Up — Epilepsy Life Source Awareness

1. Contact Information

First Name*

Last Name*

Email Address*

Phone Number

Mailing Address

City

State

ZIP Code

2. Availability

Days available (check all that apply):

Preferred time(s):

Morning (8am–12pm)Afternoon (12pm–5pm)Evening (5pm–9pm)

Other:

3. Areas of Interest & Volunteer Roles

Select all areas where you would like to contribute:

Community Outreach & Awareness — Distributing educational materials and raising awareness in the communityEvent Support — Helping plan and manage fundraising events, walks, and community activitiesSupport Groups — Facilitating or assisting with peer and family support group meetingsAdministrative Support — Assisting with office tasks, data entry, communications, and moreEducation & Fund Mentoring — Sharing knowledge and skills with others, supporting educational programs

Other:

4. Experience & Background

Do you have previous volunteer experience? If yes, please describe:

Please list any relevant skills (e.g. public speaking, graphic design, social media, medical/nursing background, etc.):

Are you comfortable using social media to help promote ELSA?

Yes

If yes, please share your social media handle (optional):

5. Emergency Contact

Emergency Contact Name*

Relationship*

Phone Number*

Volunteer Agreement

By signing below, I confirm that the information provided is accurate and that I am willing to volunteer with Epilepsy Life Source Awareness in accordance with the organization's guidelines and policies.

Signature (type your full name) *