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Canadian Liver Foundation Volunteer Application Form

Full Name
Address
City
Province
Postal Code
Email Address:*
Employer
Profession
Daytime Phone
Night time Phone
Fax Number
Cellular Number
Emergency Contact Name
Emergency Contact Phone
How did you hear about us?
Have you been convicted of a criminal offence for which a pardon has not been granted?
Yes
No
If YES, please explain:
If you have a disability, what accommodations would you need to join our volunteer team?
When are you available to volunteer?
Time of Day
Days of Week
Hours per Month
What attracted you to the Canadian Liver Foundation in particular?
I am interested in the following positions/activities. Please indicate interests below:
Sharing my story/connection to liver disease
Public speaking/presentations
Media spokesperson
Participate in a CLF event
Organize an event to benefit the CLF
Counselling/peer support
Other
What skills, training or knowledge do you wish to utilize at the Canadian Liver Foundation?
Describe a personal or work situation when you felt or would feel successful.
What training, resources or support do you anticipate needing to be successful?
Please provide two personal or professional references:
Reference1 Name
Reference1 Phone
Reference1 Relationship
Reference2 Name
Reference2 Phone
Reference2 Relationship
I hereby attest that the above information is true to the best of my knowledge.
Signature*
Today's Date

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