Thank you for your interest in becoming a volunteer.
Please answer all questions to the best of your ability, read the acknowledgment and hit 'submit.' Your application will be submitted electronically and Breast Friends will contact you.
Your Full Name
E-mail Address
Home Phone
Work Phone
Cell Phone
Fax Number
Best time to call at which number
Breast Cancer Survivor? YES NO
If yes, number of years a survivor:
Indicate Area(s) of Interest (check all that apply and list availability):
24-Hour Telephone Support Network
Please list which days/evenings of the week you can be scheduled.
Would a family member (husband, adult child, parent, sibling) be willing to participate in our peer support program and talk to a caller's family member should they need support? If yes, please state:
Name
Relationship to you
Availability
Transportation Services
Please let us know when you are available for transportation (own vehicle required).
Clerical/Office
Please indicate which days and hours you might be available. Would you prefer to come in on a regular schedule or be called on an “as needed” basis?
Fundraising
Area Events
Special Projects
Other: Would you be interested in making home or hospital visits? Please include any suggestions you have and your availability.
Tell us why you wish to become a Breast Friends volunteer?
If a survivor...
What words did you hear during your experience that helped you the most?
How did you cope with your own experience?
ACKNOWLEDGEMENT
I acknowledge that as a Breast Friends volunteer, I am only to offer peer support. I will not offer medical advice, interpret medical tests or findings, contradict, disagree or otherwise comment on treatment or recommendations made by a caller's physician. I will not refer a caller to a physician unless the caller indicates specifically that she does not have a physician or is requesting a referral for a second opinion. Nor will I comment or render an opinion about the caller's choice of physician. Furthermore, I will not use Breast Friends or its callers as a forum to express political or religious views, endorse a particular medical treatment, product or service or to conduct business activities or engage in any type of solicitation for my own part. I acknowledge that my relationship with Breast Friends is strictly voluntary, and that both parties have the right to terminate said relationship at any time without cause or prejudice. All information received is kept strictly confidential and will not be distributed in any way.
By submitting this form, I verify that I have read and understood the above acknowledgement.
