ADDA Volunteer Application & Information Form

Name: (required)
Your Email (required)
Address Line 1:
Address Line 2:
City :
State/Province:
Zip/Postal Code:
Country:
Phone Number:
Cell Phone:
Application for (Please check one): Volunteer RoleConferenceCommittee
Please check one: Adult with ADDParent of ADD ChildProfessional working with ADDOther
Why are you interested in ADDA?
Relevant experience and/or employment.
Area(s) of expertise/contributions you feel you can offer ADDA
Would you like to present the “Managing ADHD in the Workplace" presentation to organizations in your local area? YesNo
If you'd like to offer the presentation, please indicate all the cities/states or provinces where you can dispatched to speak along with the necessary delay:
(ex. New York – anytime, Ottawa – with 2 weeks’ notice, Quebec – with 1 month notice.)
Do you have other volunteer commitments?
Please provide three (3) references of people who are familiar with your expertise and/or skills:
Person 1 - Please provide name, address, phone number and email address
Person 2 - Please provide name, address, phone number and email address
Person 3 - Please provide name, address, phone number and email address