Volunteer Group Sign-up - LightHouse for the Blind and Visually Impaired

^* These fields are required.

Team Lead First Name ^*

Team Lead Last Name ^*

Team Lead Title ^*

Company, Organization or School Affiliation ^*

Contact Email ^*

Contact Phone ^*

Phone Type ^*

Street Address ^*

City ^*

State ^*

Zip ^*

Country ^*

How did you hear about LightHouse? ^*

How many members are there in your group? ^*

Is there anyone in your group under the age of 18? ^*

Please list the names of members participating.

Do you or anyone in your group have any physical, cognitive, or developmental limitations that may prevent you from safely performing certain tasks? If yes, please share below.

Has your group volunteered with blind or disability agencies before? If yes, please share below.

Distance Willing to Travel: Please select all areas you are willing to travel (ctr/cmd+click).

Please provide a few dates you’d like to volunteer. In order to better serve your group and organization, please select dates greater than 21 days from today’s date.

First Choice Date ^*

Second Choice Date ^*

Anything additional you would like us to know about your group?