Volunteer Profile

The Komen Foundation is about people - people who are committed to making a difference, people who are dedicated to fighting breast cancer by doing all they can to eradicate this disease. Thank you for your interest in volunteering your time and expertise with the Komen Lowcountry Affiliate. Please complete the contact information below and indicate your areas of interest and a Komen Lowcountry Affiliate representative will contact you about upcoming volunteer opportunities.

Name
Address
City
State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming
Zip code
Home Phone
Work Phone
E-mail Address
Contact By	E-mail Phone
I would like to receive e-mails about Komen activities
Company Name
Position

BACKGROUND
Have you ever been convicted of a felony? Yes No

Have you been charged with any crime involving a child? Yes No
If yes, Explain


Do you wish to be recognized as a breast cancer survivor? Yes No

Birth date (day/month)

If you speak a foreign language and are willing to share your skills,
please indicate which language(s)


Why do you want to volunteer for Komen for the Cure?


Have you volunteered for Komen for the Cure in the past?
If so, when & what Affiliate?



SKILLS
Please indicate if you have more than one year of experience in the following areas:

Data Entry Excel and Word Event Planning Finance Fundraising Grant Writing Advocacy

Health Care Professional Journalism Photography Public Relations/Marketing/Advertisement Public Speaking Teaching

Please list any additional skills that you would be willing to contribute



AVAILABILITY
How often would you like to volunteer? Weekly Monthly Occasionally

Daytime availability	Yes No
Evening availability	Yes No
Weekend availability	Yes No

POSITIONS
I am interested in a leadership position support position.

Please indicate all of the positions that you are interested in applying for below.

Race
Race Day Volunteer/Pre Race	Work on Race Day or at the Health Expo; multiple positions available on Race Weekend. An additional Race Volunteer Registration must be completed.
Brochure Distribution	Distribute Race brochures to local businesses in July and August.
Committee Member	Committee members work on various committees for the Race or Health Expo - year-long commitment.
Race Office Assistant	Assist Race Manager with phone calls and administrative duties from May through September.
Development/Special Events
Committee Member	Increase and diversify funding by sharing your knowledge of fundraising in monthly meetings.
Special Event Volunteer	Represent the Komen for the CureŽ at various Komen and third party events.
Development Office Asst.	Administrative duties that relate to development or special events, database experience desired.
Community Program Department
Committee Member	Participate in regular meetings to help create and implement the Community Program Department's goals and objectives. Committees include Education, Grants and Screening.
Speaker's Bureau	Speak about breast health education to community groups and organizations; training provided.
Health Fairs	Increase awareness and knowledge of breast health by handing out information and answering questions at various health fairs.
Survivor Activities	Participate as a breast cancer survivor at breast cancer conferences, Survivor Luncheon or other survivor activities.
Education Office Asst.	Perform a variety of tasks depending on project deadlines. Beginning computer skills including Microsoft Word and Excel needed. (Monday - Friday, 8:30 - 5:00 pm)
Grant Peer Reviewer	Review grant applications, assign scores and make recommendations based upon the project. Grants are reviewed every January.
Education Materials Distribution	Distribute educational materials to local health care providers.
Advocacy
Committee Member	Analyze public policy issues that affect Komen for the Cure and breast cancer, making recommendations for action.
eChampion	Receive e-mail alerts on how you can help drive public policy by educating Congress, federal officials and state legislators on issues effecting breast cancer screening, treatment and survivorship.
Administrative
Data Entry	Enter data into our database, or perform other computer work involving Microsoft Word or Excel during office hours (Monday - Friday, 8:30 - 5:00 pm).
Office Assistant	Assist program managers with various administrative duties that do not include the computer during office hours (Monday - Friday, 8:30 - 5:00 pm)
Miscellaneous
Photographer	Photographer needed with some professional experience for various events.
Writer	Assist with writing or editing newsletter articles, annual report and other miscellaneous articles.

KOMEN VOLUNTEER RELEASE

Emergency Contact
Name:      Phone:
Relationship to Volunteer:

I wish to volunteer for the Lowcountry Affiliate of Susan G. Komen for the CureŽ. I understand that the nature of volunteer activities that I may perform in my capacity as a volunteer may involve physical activity, contact with unidentified or unfamiliar persons, or other potential risk of bodily injury or damage to property. Knowing this, I hereby assume full and complete responsibility for any personal injury and/or property damage that I may sustain or cause during my participation as a volunteer. In addition, I hereby release, hold harmless & covenant not to file suit against the Komen Affiliate, Susan G. Komen for the Cure, Inc. and of their employees, volunteers, partners, agents, Sponsors, Board Members and Successors from any and all loss, liability or claims I may have arising out of my service as a volunteer. I understand that as a volunteer, I may become privy to confidential information about the Komen Affiliate or Susan G. Komen for the Cure. I agree to maintain the confidentiality of any information marked "confidential" as well as any information about the Komen Affiliate's or Susan G. Komen for the Cure's internal procedures, business operations, personnel information and the like that is not otherwise publicly disclosed by the Komen Affiliate or Susan G. Komen for the Cure. I will not use any confidential information in any manner that would be detrimental to the Komen Affiliate or Susan G. Komen for the Cure, and I will avoid any actions that might impair the reputation of the Komen Affiliate or Susan G. Komen for the Cure.

Thank you for your interest in volunteering with the Lowcountry Affiliate of Susan G. Komen for the CureŽ. We appreciate your offer to share your time and talents with us. We will contact you once we have received your completed application.

**This release must be received prior to volunteer involvement.

I have read and agree to the terms above. The information I have provided is accurate and complete.