Survey - Long Island Volunteers

Contact Information

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Name:

First Required	Last Required

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Email: Required

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Street 1: Required

Street 2:

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City/State/ZIP:

City Required	State Required	ZIP Required

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Phone Number Required

Yes, I would like to receive e-mail from Autism Speaks

Yes, I would like to receive postal mail from Autism Speaks

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Question - Not Required - Company Name

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Question - Required - Relationship to Autism

Question - Not Required - General Volunteer Projects

	Tabling / Outreach Opportunities
	Phone Calls (Daytime)
	Phone Calls (Evening)
	Speaking Opportunities
	Data Entry
	Packet Assembly
	Other (Please list in comments)

Question - Not Required - Community Education and Awareness Projects:

	Autism Awareness Month / Light It Up Blue
	Family Days
	Presentations and Introduction Meetings
	Calls to Local Providers

Question - Not Required - Publicity Projects:

Question - Not Required - Team Development Projects:

Question - Not Required - Corporate Development Projects:

	Sponsorship
	Corporate Teams
	Promotions (example: Puzzle Piece Campaigns)
	Corporate Breakfast

Question - Not Required - Special Events Projects:

	Awards Reception
	Thons (example: Bowl-a-Thons)
	Kick Off Reception
	Galas (example: Chefs Gala)
	Other (Please list in Comments field)

Question - Not Required - Walk Logistics Projects:

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Question - Required - Are you a return walker?

Question - Not Required - Walk Team Name:

Question - Not Required - Comments: