Sign in if you already have an account.
         
Susan G. Komen
   
donate.gif
GET INVOLVED
Volunteer
Komen Activities
Advocacy
Fundraising for Komen
Social Media
National Spotlight

Financial Resources — Did you know that there are many financial resources that can help people living with breast cancer? Find out more

Rally for the Cure — Golf, tennis, dinner events and so much more...

Go Passionately Pink to help save lives! — Just wear pink, have fun and raise money to fight breast cancer. Be inspired by the multitude of ideas right here, or think of your own. There are so many creative ways to have fun and fight breast cancer.

Komen Twin Tiers - Volunteer App & Waiver

 

Komen Twin Tiers Volunteer Application

*1.
Question - Required - Date




2. Your information:

*

Name:

 

 

   

*

*

*

City/State/ZIP:

 

    

*

*

*

 

Date of Birth:

 

 


*3.


4.


5.  


6.

7.


8.  


*9.
Question - Required - Please indicate if you have more than one year of experience in the following areas: (You may select multiple areas)

10.  


11.
Question - Not Required - How often would you like to volunteer?



12.


13.


14.


15.
Question - Not Required - I'm interested in a:


16.

 

Emergency Contact:

17.  


18.  


19.  


 

I wish to volunteer for Susan G. Komen Twin Tiers Region. I understand that the nature of volunteer activities that I may perform in my capacity as a volunteer may involve physical activity, contact with unidentified or unfamiliar persons, or other potential risk of bodily injury or damage to property. Knowing this, I hereby assume full and complete responsibility for any personal injury and/or property damage that I may sustain or cause during my participation as a volunteer. In addition, I hereby release, hold harmless & covenant not to file suit against the Komen Affiliate, Susan G. Komen and of their employees, volunteers, partners, agents, Sponsors, Board Members and Successors from any and all loss, liability or claims I may have arising out of my service as a volunteer. I understand that as a volunteer, I may become privy to confidential information about the Komen Affiliate or Susan G. Komen. I agree to maintain the confidentiality of any information marked “confidential” as well as any information about the Komen Affiliate’s or Susan G. Komen’s internal procedures, business operations, personnel information and the like that is not otherwise publicly disclosed by the Komen Affiliate or Susan G. Komen. I will not use any confidential information in any manner that would be detrimental to the Komen Affiliate or Susan G. Komen, and I will avoid any actions that might impair the reputation of the Komen Affiliate or Susan G. Komen.

*20.  


21.  


 
   Please leave this field empty