Volunteer Interest Form

Name
Address
City
State Zip
County
Phone Number (day)
Phone Number (night)
E-Mail
Birthdate

Check any that apply:

Retired (type of work)
Employed (hours per week)
Homemaker
Student
Not Working

Please check all areas that are of interest to you:


Personal Advocate
Community Educator
Elder Friendly Business Evaluator
Elder Friendly Web Evaluator
Fund Raising/ Special Events
Commission Member/Advocacy
Marketing/ Publicity
Writing /Newsletter
Agency Internship

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Elders in Action
1411 SW Morrison St Suite 290 - Portland, OR 97205
PH: 503-235-5474 FAX: 503-595-7599
E-mail: info@eldersinaction.org