Name *

First Name

Last Name

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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Name *

First Name

Last Name

Phone *

(###)

###

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Please select your preferred Volunteer Opportunity *

Program Volunteer (Brain Power Hour Walking Group - Saskatoon & Kindersley)

Program Volunteer (Social Beans Coffee Group - Saskatoon & Regina)

Brain Boogie Walk (Province Wide - Late Aug & Early Sept)

Fall Retreat (Regina - Oct)

Spring Retreat (Saskatoon - Mar)

Event Volunteer

Occasional Volunteer

Are you or have you volunteered at other organizations: *

Yes

No

Do you have a Criminal Record Check that you can provide to SBIA? *

A Criminal Record Check may be required by volunteers. SBIA will reimburse you for the cost.

Yes

No

Do you have transportation to volunteer assignments?

Yes

No

Please check off which areas apply to you:

I would like to be a member of the Saskatchewan Brain Injury Association

I would like to volunteer at a fundraising event, on a committee or on event day

I would like to help fundraise for the Brain Boogie in August

I am comfortable in a public speaking role

I am comfortable contacting people by telephone or in person

Computer Experience (Word, Spreadsheets, Email, etc.)

I am 18 or older. *

Yes

No

I am 17 or under and understand that I am required to submit the waiver signed by my parent or guardian in order to volunteer. *

Yes

No

Name *

First Name

Last Name

Phone *

(###)

###

####

*

I give permission for a representative of SBIA to contact the person(s) above for the purpose of check- ing my references to determine my suitability for a volunteer position with the Association and commit that all above information is valid

I would like to receive occasional emails from SBIA in regards to volunteer opportunities.

By submitting this form you are agreeing to our Volunteer Policies as well as our waiver. I hereby author- ize Saskatchewan Brain Injury Association to release and to publish, in print or non - print form, any pho- tographs, videos or recordings taken of my children and/or myself while attending this event