British Columbia Persons with AIDS Society - Volunteer Application Form

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First Name:
Last Name:
Address:
City:
Province:
Postal Code:
	*Can you be discreetly contacted by mail?* Yes No
Phone:
	*Can we say we are calling from BCPWA?*
	Yes No
Cell:
	*Can we say we are calling from BCPWA?*
	Yes No
Email Address:
	*Can we contact you by Email?*
	Yes No
Date of Birth:	month: day: year:
Gender:	Male Female Transgendered
Ethnicity (optional):
*Are you a voting member of the BCPWA Society?*
	Yes Card number: No
*Emergency Contact Person*
Name:
Relationship:
Phone:
*How did you hear about volunteering for the BCPWA Society?* BCPWA Society Website Living+ Magazine Newspaper/Radio/TV Volunteer Centre/Website BCPWA Society Presentation HIV-Positive Person BCPWA Volunteer/Staff Other (please specify)
*Why do you want to volunteer for the BCPWA Society?* Community involvement School related experience Socialize Community volunteer program Learn new skills Other (please specify)
*Have you ever volunteered for BCPWA before?* Yes No If so, when? In which program?
*Please provide us with 2 reference names and their contact numbers:*
Name:
Phone:
Type of reference:
Name:
Phone:
Type of reference: