Please take a minute to share some information with us! If you have suggestions or ideas, you may use this form to include them as well!
Volunteer Inquiry Form
(All information is confidential and optional to provide)
First Name
Last Name
Which age group do you fit in?
Under 10 years
10-15 years
16-20 years
21-30 years
31-40 years
40 something
50 something
60+
Address
City
State
Zip Code
Home Telephone
Work Telephone
Graduating Year
Email Address (example: marysmith@aol.com)
Are you interested in becoming a local or area Ambassador for this program?
Yes
No
Why do you feel you'd make a good Ambassador?
Provide your questions or comments here!
How did you hear about our
The Difference Maker
Organization?
Choose the best way for us to contact you:
Phone - Daytime
Phone - Evening
Email
High school/college students: To verify you are "real" we need the name of your school, their phone number, a teacher's name, email and phone number so they can verify you are the "real deal!" If you are out of school, then we need a place of work/supervisor information. (Home schooled? No worries....just indicate you are home schooled and we can provide other ways for you to verify that you are a trustworthy individual.
- THANK YOU -
Thank you for your comments or questions. We'll be in contact with you very soon if there is a need. In the meantime, please enjoy our site after you click on SUBMIT.
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