Author: hopalia

Ambassador/Volunteer Information

Contact Information

Name:
(Last) (First) (Middle)
Address:
(Street) (City) (State) (Zip)
Day Phone: Cell Phone: Evening Phone:
May we contact you by email? If Yes:

School Information

Is your volunteer service for credit?: Yes No
School: Contact Name:
Phone: Email:
Address:
(Street) (City) (State) (Zip)

Skills and Experience

Work experience or skills relevant to requested volunteer position:
Previous volunteer experience:

How did you hear about our Ambassador program?

Internet Event Booth Media Directly
Speaker Newsletter Friend/Relative Other

What Volunteer Activities would you like to do?

(Please check all that apply)
I am willing to volunteer in any capacity
I would like to volunteer in the areas selected:
Public Education
Fundraising
Special Events
Outreach Minority Intervention and Kidney Education (M.I.K.E)

Availability

Which days and times are you available? (Please check all that apply)
I am available for the following times:
Monday: morning afternoon evening
Tuesday: morning afternoon evening
Wednesday: morning afternoon evening
Thursday: morning afternoon evening
Friday: morning afternoon evening
Saturday: morning afternoon evening
Sunday: morning afternoon evening
For a specified event only
I would prefer to volunteer (Please check all that apply):
All Year Spring Summer Fall Winter
How much time would you like to volunteer each month? (Please check all that apply)
Less than one full day:
8 to 20 hours:
21 to 40 hours:
More than 40 hours:

Please submit volunteer information to one of the following locations:

American Kidney Fund National Office
Attn: Ambassadors Program
6110 Executive Boulevard, #1010
Rockville, MD 20852
Fax to 301-881-0898
American Kidney Fund Northeast Regional Office
Attn: Ambassadors Program
265 Spagnoli Road, Suite 2
Melville, NY 11747
Fax to 631-470-4792

American Kidney Fund North Central Office
Attn: Ambassadors Program
c/o Komed Holman Center
4259 South Berkeley
Chicago, IL 60653
Fax to 312-238-9464
American Kidney Fund Southeast Regional Office
Attn: Ambassadors Program
72 Edgewood Avenue
Atlanta, GA 30303
Fax to 404-222-0711