American Lung Association of Oregon - Volunteer Application

Volunteer Application Form

Apply to become an American Lung Association of Oregon volunteer by completing this form. Your personal information will be kept strictly confidential. Please refer to our privacy policy for details.

1) Contact Information:

First Name:		Last Name:
Address:
Address2:
City:		State:
Zip:		Day Phone:
Email:		Night Phone:

2) Emergency Information:

Emergency Contact First Name:		Emergency Contact Last Name:
Emergency Contact Address:
Emergency Contact Address2:
Emergency Contact City:		Emergency Contact State:
Emergency Contact Zip:		Emergency Contact Phone:
Physician's Name:
Physician's Phone:

3) Other Information:

Available Days:
Available Hours:
Education/ Training
Skills & Interest
Languages
Past Volunteer Experience:
Why do you want to volunteer for the American Lung Association of Oregon?

4) Volunteer Opportunities Chooses:

Check the boxes next to the areas you're interested in volunteering for:

Office Operation

	Receptionist		Data Entry
	Bulk Mailings		Filing
	Financial Assistant

Advocacy

	Asthma		Clean Air
	Telephoning		Tobacco
	All ALAO Advocacy

Education

	Clean Air		Lung Education
	Tobacco		Support Groups

Events

	Asthma Walks			Health Fairs
	Reach the Beach			Reach the Summit

Other Volunteering

Please add me to the Breathing in Oregon mailing list. BIO is a free, quarterly newsletter of the American Lung Association of Oregon.

Please have the Volunteer Coordinator for the American Lung Association of Oregon contact me by phone.

If you have further questions, please contact volunteer@lungoregon.org or call 503-718-6143.

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American Lung Association® Donation Information Join us in our mission to prevent lung disease and promote lung health.

7420 SW Bridgeport Road, Suite 200 Tigard, OR 97224-7790

Tel: (503) 924-4094 Fax: (503) 924-4120

Call 1-800-LUNG-USA to reach the Lung Association in your state.