National MS Society: Survey

NCP Volunteer

1.

Please enter your personal information:

If you have previously registered, please to prepopulate your information.

*

Name:

Title	First Required	Middle Required	Last Required

*

Email: Required

*

Street 1: Required

Street 2:

*

City/State/ZIP:

City Required	State/Province Required	ZIP/Postal Code Required

*

Country: Required

*

Phone Number: Required

Employer:

Occupation:

Gender:

*

Date of Birth: Required

Date of Birth:

Month

Day

Year

Yes, I would like to receive important email updates - including event announcements - from the National MS Society.

Yes, I would like to receive important postal mail updates - including event announcements - from the National MS Society.

Remember me. What's this?

Please enter a username and password that you can use when you return. You can use this password to update your information or receive personalized content.

*	Username: Required	5 to 60 characters
*	Password: Required	5 to 20 characters
*	Confirm Password: Required

2.

Question - Not Required - Cell Phone Number

3.

Question - Not Required - Work Telephone

4.

Question - Not Required - May we contact you at work?

*5.

Question - Required - Emergency Contact. (Name, Relation and Phone Number)

(Maximum response 255 chars, approx. 5 rows of text)

6.

Question - Not Required - Are you Retired?

7.

Question - Not Required - Have you volunteered with the NMSS before?

8.

Question - Not Required - How do you relate to MS?

9.

Question - Not Required - Do you know how to use a computer?

10.

Question - Not Required - Do you have remote access to a computer?

*11.

I would like to volunteer to help with:

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

*12.

I would like volunteer to provide administrative assistance and support:

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

13.

Question - Not Required - Comments:

National Multiple Sclerosis Society

Accessibility Navigation:

Site Search:

Resource Navigation:

Primary Navigation:

Breadcrumb Navigation:

Section Navigation:

NCP Volunteer

NCP Volunteer

Footer Navigation: