VOLUNTEER-FUNDRAISING: Registration Form

TITLE (required)

FIRST NAME (required)

SURNAME (required)

ADDRESS LINE 1 (required)

ADDRESS LINE 2

TOWN/CITY (required)

POST CODE (required)

CONTACT TELEPHONE NUMBER (required)

EMAIL ADDRESS (required)

PLEASE CONFIRM THAT YOU ARE AGED 16 OR OVER (This is the minimum age requirement) (required)

PREFERRED COLLECTING LOCATIONS (please select ALL that apply)

FALKIRK AREASTIRLING AREACUMBERNAULD/KILSYTH AREACLACKS AREA (ALLOA/TILLICOULTRY etc)DENNY/LARBERT/STENHOUSEMUIRBO’NESS/LINLITHGOW/GRANGEMOUTHDUNBLANE/BRIDGE OF ALLANCALLANDERBALFRONABERFOYLE

VOLUNTEERING ACTIVITIES (required)

Light Up A Life Campaign (Nov-Dec)Snowdrop Appeal (Jan-Feb)Summer Raffle Promotion (June-Aug)Charity Can Collector (Shops)Community Collections: at Supermarkets / Concerts/Festivals/Fayres/ Sports Events etc.Hospice Representative-Cheque PresentationsSpeaker at Supporter EventsHospice Event Helper/MarshallSchools Liaison

PREFERRED VOLUNTEERING DAY

Weekday (MON-FRID)Weekend (SAT-SUN)Any

HOW DID YOU FIND OUT ABOUT VOLUNTEERING FOR STRATHCARRON HOSPICE ? (required)

COMMENTS

HEALTH/DISABILITY INFORMATION At some of our collection locations Volunteers may be required to stand. Do you have any accessability or mobility considerations ? Please specify below.

Via Email

YESNO

Via Telephone

YESNO

Via Post

YESNO