MS Queensland

VOLUNTEER CONTACT DETAILS

Title
MrMrsMissMsDr
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First Name *

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Surname *

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Birth Date

Day *
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Month *
JanFebMarAprMayJunJulAugSepOctNovDec
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Year *

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Postal Address *

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Suburb *

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State *
QLDNSWACTVICSAWANTTAS
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Postcode *

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Daytime Phone *

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Mobile*

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Email*

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Organisation *

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Existing Medical Conditions or Allergies

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Please specify your volunteer tshirt size *
SmallMediumLargeX LargeXX Large
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EMERGENCY CONTACT DETAILS

Title *
MrMrsMsMissDr
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First name *

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Surname *

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Relationship to Volunteer *

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Daytime Phone *

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Mobile

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VOLUNTEER DUTIES

Please advise which days you are available to volunteer: *
MS Moonlight Walk - Friday 14 October 2011
MS Brissie to the Bay 2012 - Sunday 24 June 20112

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Please tick which duties you would prefer. (Please note: We will make every effort to accommodate your preferences, however this may not be guaranteed) *
On-Course Marshall
Information/Registration
Left Luggage Assistant
Rest Stop/Recovery Assistant
Merchandise Sales
General Tasks

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Please feel free to include a comment here (eg: if there are other volunteers you wish to be placed with on the day, or if you have special requirements)



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