Name *

First Name

Last Name

Mobile Phone *

(###)

###

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Which area(s) are you interested in volunteering? *

Mediation

Facilitation

Training / Teaching

Coaching

General Administrative

Fundraising

Case Intake/Management

Board of Directors

Other

I hereby certify that statements made on this application are true and correct to the best of my knowledge. I understand that by submitting this application I authorize inquiries to be made concerning my character for purposes of determining my suitability as a volunteer. I agree to abide by the policies and procedures of the NMC in performing my duties. *

I agree

I commit to at least two years of service and 50 hours per year working with NMC as a volunteer. *

I agree

I understand that all volunteers at NMC must pass a background check prior to starting work. *

I agree

Date *

MM

DD

YYYY