Volunteer Form


Volunteer Form for the MSHA Annual Conference
                         March 22-24, 2012 ~ Radisson Plaza Hotel ~ Kalamazoo, Michigan

Please complete this form and return to the MSHA office along with your
MSHA Conference Registration Form. 

You should Volunteer at the MSHA Conference if you are:

√ Willing and able to volunteer your time at the conference
√ A MSHA Student Member (conference registration is just $20 for MSHA Students members and they must commit to a volunteer assignment)

Most volunteer assignments will be for approximately 1-2 hour time commitments.  You will receive notification of your assignment prior to conference.

Please check appropriate boxes:

/  / Yes, I can volunteer.  I would like to:

/  / Moderate a Session.   Please respond by February 1, 2012
/  / Work a shift at the Registration Table (see shifts below)
/  / Help out at a Forum (Public School or Medical Speech-Language Pathology)
       on Saturday (collect lunch tickets, distribute materials, etc.)
/  / Help with a Short Course (collect tickets, distribute materials)
 
Name:____________________________________________________________________________________

Address:_______________________________________________  City/State/Zip:____________________

Phone:  Day:(______)______________________    Evening:(_______)_____________________________

Email address:___________________________________________________________________________

/  /  Student:  University: ___________________________________                                             

Please circle the times you are available:

Thursday, March 22 Friday, March 23 Saturday, March 24
12:00 noon-2:00 pm 7:00-9:00 am 7:30-9:30 am
4:00-6:00 pm 8:30-10:30 am 9:00-11:00 am
  10:00 am-12:00 noon 10:30 am-12:30 pm
  11:30 am-1:30 pm 12:00 noon-2:00 pm
  1:00-3:00 pm 12:30-2:30 pm
  2:30-4:30 pm  

     

Thanks for your help!  You will receive a confirmation in writing.  Please return this form as soon as possible, but no later than March 10, 2012 (February 1 for Moderators).


Return to:  MSHA ~  790 W. Lake Lansing Rd. Suite 500-A
East Lansing, Michigan  48823    517/332-5691  Fax: 517/332-5870    email: msha@att.net                
Website: www.michiganspeechhearing.org