Survey - Pedaling for Parkinson's: Volunteer

Pedaling for Parkinson's: Volunteer

1.

Please share your contact information:

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

*

Name:

First Name Required	Last Name: Required

*

Email: Required

Street 1:

Street 2:

City/Province/Postal:

City	State	Postal

Phone Number (555-555-5555):

YES, by checking this box I would like to receive updates and information from Parkinson Canada. We're so thankful for your support. Please check the box and allow us to tell you the impact you are making for people living with Parkinson's.

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Please enter a user name and password for logging in 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
*	Repeat Password: Required

2.

Question - Not Required - Please select volunteer roles that are of interest to you:

	Registration
	Support at central location (i.e. food prep, rider check in, etc.)
	Route marshall/support on course
	Work with or help to run a rest station
	Safety / route sweeper
	Logistics (i.e. placement / return of signage)
	Registration and rider check in

3.

Question - Not Required - Which location are you looking to volunteer with:

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

4.

Question - Not Required - Please share any other details:

*5.

Question - Required - Please enter the text you see:

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