Volunteer for PHA form

Name

First

Last

Email

Phone

Address

Address Line 1

City

State

Zip Code

Date of Birth

Which of the following describes you?

You answered OTHER to the above question. Can you provide a brief description?

When were you or the patient in your life diagnosed?

Month

Year

Are you a member of PHA?

Do you speak any languages other than English?

What other languages do you speak?

Which volunteer opportunities are you interested in?

Legislative Advocacy - tell your elected officials about PH
Special Events and Fundraising
PHA Support Line - provide emotional support for those affected by PH via phone (1-week shift)
PHA Peer Mentor - provide support for those affected by PH via email
PHA Support Group Leader - plan and run local support group meetings
PHA Facebook Group Moderator - moderate and support members of PHA's Facebook groups
Other

Advocacy

I want to contact my Members of Congress a few times a year
I have experience contacting Members of Congress and want to mentor new advocates

Special Events

Are you currently working?

Support Line

Peer Mentor

Support Groups

Facebook Group Moderator

You answered OTHER to the above question. Please describe the volunteer opportunity that interests you.

Why do you want to volunteer with PHA?

What strengths will you bring to this role?

How did you find PHA?