ICAN SERVE Volunteer Sign Up Form

  • The foundation has regular events and other special activities and is always in need of volunteers to keep its events going.
  • There is always a need for a pool of breast cancer survivor volunteers willing to undergo training in counseling other breast cancer survivors.
  • Cancer survivors, doctors, relatives of cancer patients, other caregivers willing to speak during forums and counsel families taking caring for cancer patients are always welcomed.
  • If you have a special skill that can benefit the foundation operations, please let us know.

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Cancer Survivor: Yes No     If Cancer Survivor:   Stage:
First Name:     Last Name:     Nick Name:
Home Phone:    Mobile Phone:
Street:    City:    Zip Code:
Email:    Date of Birth:    Civil Status:
Person to contact incase of emergency:
Name of Company:     Title/Position:
PLEASE SELECT WHICH VOLUNTEER OPPORTUNITIES YOU ARE INTERESTED IN?
1. Education (help us plan ways to disseminate breast and gynecologic health information)
2. Resource mobilization (help in fundraising and special events and developing partnerships)
3. Advocacy (assist in networking and establishing linkages with government and health care institutions)
4. Patient services (provide counseling and patient assistance e.g. home visits, answer info hotlines)
5. Administrative work (provide admin office support such as materials’ preparation, encoding of data, filing, etc.)
6. Communication/Media (contribute articles, handle media interviews, etc.)
DO YOU HAVE SPECIAL SKILLS THAT COULD BENEFIT THE ICS?
PLEASE INDICATE WHAT DEGREE OF VOLUNTEER COMMITMENT YOU ARE WILLING TO COMMIT AT THIS TIME
1. Willing to commit time every week (may include working at the ICS for a designated number of hours every week)
2. Willing to commit several hours a month (may include attending a meeting or spending a few hours a month working on committee assignments)
3. Willing to commit block of time at periodic intervals (requires a time commitment of a couple of hours at various times during the year to help with a special event or task)
4. Willing to work on event day only (may include attending a pre-event volunteer orientation)
I am available to volunteer: Weekdays Weeknights Weekends
Special Remarks: