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BHAWD Volunteer Information Form

First Name:
Last Name:
     Address:
         City: ,
       State: Zip Code;

   Home Phone:
    Work Phone:
E-Mail Address:

Date of Birth (optional : for recognition purposes only):

When would you like to volunteer? (check all that apply)
     Weekdays
     Mornings
     Afternoons
     Other (Specify)

Skills and Interests: (Check all that apply)
     Data entry
     Word Processing
     Mailing
     Government Relations
     General Office
     Information and Referral
     Public Speaking
     Graphic design/Layout
     Phone work
     Health Education
     Other (Specify)

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