Survey - Equitas Health Volunteer Orientation Sign Up

Dates remaining for 2017 by region:

Central Ohio:

Wednesday, May 24, 6-9pm

Wednesday, June 28, 5:30-8:30pm

Wednesday, July 26, 5:30-8:30pm

Wednesday, August 23, 5:30-8:30pm

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

Wednesday, October 25, 5:30-8:30pm

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 a user name and password for logging in when you return. You can use this password to update your information or receive personalized content.

*	User Name: Required	5 to 60 characters
*	Password: Required	5 to 20 characters
*	Repeat Password: Required

Please enter one of the following. One phone number is required. Having the correct information to reach volutneers 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, May 24, 6-9pm
Wednesday, June 28, 5:30-8:30pm
Wednesday, July 26, 5:30-8:30pm
Wednesday, August 23, 5:30-8:30pm
Wednesday, September 27, 5:30-8:30pm
Wednesday, October 25, 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.