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Contact Information
First Name
Last Name
Organization:
Email Address
Address, line 1
City
State
Zip Code
Phone
What is your preferred method of communication?
Email
Phone call
Text message
Are you or a loved one in recovery or an alum of POWER?
I am a POWER alum.
I am in recovery but not a POWER alum.
I have a loved one who has struggled with substance use.
None of the above
Prefer not to answer
Are you interested in any of these volunteering opportunities?
Leading an exercise class
Tutoring
Teaching a skill
Teaching a craft
Helping staff with clerical work
Helping staff with fundraising projects
Gardening/Landscaping
Other
Are there any other volunteer activities that you are listed in helping with? List below.
How did you hear about POWER?
When is the best time of the week/day for you to volunteer?
Publish my name in photo captions as follows (ex. John Doe)*
I have read and agree to the Confidentiality Agreement below:
Yes
No
I consent to the Release Form below:
Yes
No
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