Survey - Equitas Health Volunteer Orientation Sign Up

Dates for Spring 2018:

Wednesday, May 23, 5:30-8:30pm (FULL)

Wednesday, June 27, 5:30-8:30pm

More dates to be announced soon!

Please Note: If you already get email from Equitas Health, have ever made a donation, or the system gives you an error, you have already have an account with us. To get your account information, please go here to login or to find your username and password. While you are there, please update your contact information.

1.

Please enter information about you:

*

Name:

Title	First Required	Last Required	Suffix

*

Email: Required

*

Street 1: Required

*

City/State/ZIP:

City Required	State Required	ZIP Required

Gender:

*

Date of Birth: Required

Date of Birth:

By signing up, you will receive periodic updates and communications from Equitas Health.

Yes, I would like to receive postal mail from Equitas Health

Please enter one of the following. One phone number is required. Having the correct information to reach volunteers is essential.

2.

Question - Not Required - Phone Number

*3.

Question - Required - Is it ok to leave messages?

*4.

Question - Required - Which volunteer training date would you like to sign-up for? Wednesday, June 27, 5:30-8:30pm

*5.

How did you hear about volunteering with Equitas Health?

(Select one of the available choices or enter a different value.)
Question - Required -

6.

Question - Not Required - Have comments? Questions?

*7.

Question - Required - Which city in Ohio are you closest to?

Have Questions? Contact our Volunteer Coordinator, Ashley McIntosh at ashleymcintosh@equitashealth.com or 614-340-6744 Ext. 104.