PACIFIC NORTHWEST VOLUNTEER APPLICATION - Questions? Please call the Regional Office at 425.251.5252 or 888.364.MADD.Thank you for taking the time to fill out this application.

PERSONAL INFORMATION

Name:

Home Address : 

City/State/ Zip: 

Primary Contact: (circle one ) Email/ Cell Phone/ Home Phone/ Work Phone:

Secondary Contact: (circle one ) Email/ Cell Phone/ Home Phone/ Work Phone:

The best time to contact me is:

(Circle the one that applies):           

VOLUNTEER INTEREST

(Circle each one that applies):

Time available for MADD activities (Check each one that applies) :

• Why do you want to become a MADD  Volunteer?
• What skills do you most enjoy using?
• What skills do you least enjoy using?
• What hobbies or activities do you enjoy doing?
• Are you volunteering for MADD as part of a court-appointed community service obligation?If yes, please explain.

(Please list two personal references that a MA DD representative may contact.)

Name: 

Contact Phone:

How do you know this person?

How long have you known this person?

Name:

Contact Phone:

How do you know this person?

How long have you known this person?

PLEASE RETURN APPLICATION TO:

MADD - PACIFIC NORTHWEST REGION

18000 72ND AVE S., SUITE 180   

KENT, WA  98032

Fax to 425.251.5253

Email: info@maddpnw.org