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Devil Killer Is Here MiNi Shell

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Current File : /hermes/sb_web/b2432/ymcamedia.ipower.com/forms/Volunteer_Form.html

<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
<title>YMCA Volunteer Survey Application Form</title>
<script language = "Javascript">
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<style type="text/css">
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body,td,th {
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</head>
<body>
<form id="form1" name="form1" method="post" action="proc_vol.php" onSubmit="return ValidateForm()">
  <h3>YMCA of Metropolitan Atlanta</h3>
  <h2> PROGRAM VOLUNTEER INTEREST SURVEY </h2>
  <strong>PERSONAL</strong>
  <table width="800" border="0" cellspacing="0" cellpadding="3" style="border: solid #333 2px;">
    <tr>
      <td style="border-bottom: solid #333 2px;"><table width="400" border="0" cellspacing="0" cellpadding="0">
        <tr>
          <td>Last Name <br />
            <input name="textfield1" type="text" id="textfield1" size="25" /></td>
          <td>First Name <br />
            <input name="textfield2" type="text" size="15" /></td>
          <td>Middle Initial <br />
            <input name="textfield3" type="text" size="3" /></td>
        </tr>
      </table></td>
      <td rowspan="2" valign="top" style="border-left: solid #333 2px;">Day Time Phone:
        <input name="textfield7" type="text" id="textfield7" />
      <br />
      Evening Phone:
      <input name="textfield8" type="text" id="textfield8" />
      <br />
      E-mail Address:
      <input name="textfield9" type="text" id="textfield9" size="35" />
      <br />
      Best time to contact you:
      <input name="textfield10" type="text" id="textfield10" size="8" />
      <br />
      By phone or email?:
      <input name="textfield11" type="text" id="textfield11" size="8" /></td>
    </tr>
    <tr>
      <td width="400">Street Address<br />
        <input name="textfield26" type="text" id="textfield26" size="60" />
        <br />
        <table width="400" border="0" cellspacing="0" cellpadding="0">
          <tr>
            <td>City<br />
            <input name="textfield4" type="text" id="textfield4" size="25" /></td>
            <td>State<br />
            <input name="textfield5" type="text" id="textfield5" size="10" /></td>
            <td>Zip<br />
            <input name="textfield6" type="text" id="textfield6" size="10" /></td>
          </tr>
      </table></td>
    </tr>
  </table>
  <strong><br />
  INTEREST SURVEY</strong>
  <table width="796" border="0" cellspacing="0" cellpadding="0" style="border: solid #333 2px;">
    <tr>
      <td style="padding: 3px; border-bottom: solid #333 2px;">Why are you interested in volunteering with the Metro AtlantaYMCA?<br />
      <textarea name="textfield12" cols="90" id="textfield12"></textarea></td>
    </tr>
    <tr>
      <td style="padding: 3px; border-bottom: solid #333 2px;">Is there a specific YMCA branch, site, or geographical area in metro Atlanta in which you&rsquo;d like to volunteer?<br />
      <textarea name="textfield13" cols="90" id="textfield13"></textarea></td>
    </tr>
    <tr>
      <td style="border-bottom: solid #333 2px;"><table width="796" border="0" cellspacing="0" cellpadding="0">
        <tr>
          <td style="padding: 3px;">In what program area(s) are you interested?<br />
            (Note: not all programs are available at all branches)<br />
            <table width="100%" border="0" cellspacing="0" cellpadding="0">
              <tr>
                <td valign="top" nowrap="nowrap"><input name="checkbox1" type="checkbox" id="checkbox1" value="checkbox" />
                  Teen Leadership &amp; Development<br />
                  <input type="checkbox" name="checkbox2" value="checkbox" />
                  Child Care<br />
                  <input type="checkbox" name="checkbox3" value="checkbox" />
                  Mentoring or Tutoring<br />
<!--                  <input type="checkbox" name="checkbox4" value="checkbox" />
                  Service Learning Opportunities<br />
-->                  <input type="checkbox" name="checkbox5" value="checkbox" />
                  Coaching or Officiating<br /></td>
                <td nowrap="nowrap"><input type="checkbox" name="checkbox6" value="checkbox" />
                  Health &amp; Wellness <br />
                  <input type="checkbox" name="checkbox7" value="checkbox" />
                  Aquatic<br />
                  <input type="checkbox" name="checkbox8" value="checkbox" />
                  Member Services<br />
                  <input type="checkbox" name="checkbox9" value="checkbox" />
                  Policy (Boards, Committees)<br />
                  <input type="checkbox" name="checkbox10" value="checkbox" />
                  Clerical/Administration</td>
              </tr>
              <tr>
                <td colspan="2"><input type="checkbox" name="checkbox11" value="checkbox" />
Guest Speaker/Workshop Presenter, Topic(s): <br />
<input name="textfield14" type="text" id="textfield14" size="50" /></td>
                </tr>
              <tr>
                <td colspan="2"><input type="checkbox" name="checkbox12" value="checkbox" />
Other:
  <input name="textfield15" type="text" id="textfield15" /></td>
              </tr>
            </table></td>
          <td valign="top" style="padding: 3px; border-left: solid #333 2px;">Other interest areas:<br />
            <input type="checkbox" name="checkbox13" value="checkbox" />
            Arts<br />
            <input type="checkbox" name="checkbox14" value="checkbox" />
            Environment<br />
            <input type="checkbox" name="checkbox15" value="checkbox" />
            Education<br />
            <input type="checkbox" name="checkbox16" value="checkbox" />
            Community Concerns<br />
            <input type="checkbox" name="checkbox17" value="checkbox" />
            Global/International Issues<br />
<!--            <input type="checkbox" name="checkbox18" value="checkbox" />
            Health &amp; Wellness<br />
-->            <input type="checkbox" name="checkbox19" value="checkbox" />
            Other:
            <input name="textfield16" type="text" id="textfield16" /></td>
          <td valign="top" nowrap="nowrap" style="padding: 3px; border-left: solid #333 2px;"><p>With what age group(s) would you like to work?<br />
              <input type="checkbox" name="checkbox20" value="checkbox" />
            Elementary School and Younger (under 12)<br />
            <input type="checkbox" name="checkbox21" value="checkbox" />
            Middle School  (12 - 14)<br />
            <input type="checkbox" name="checkbox22" value="checkbox" />
            High School  (15 - 18)<br />
            <input type="checkbox" name="checkbox23" value="checkbox" />
            Young Adult (19 - 30)<br />
            <input type="checkbox" name="checkbox24" value="checkbox" />
            Adult<br />
            <input type="checkbox" name="checkbox25" value="checkbox" />
            Older Adult<br />
            <input type="checkbox" name="checkbox26" value="checkbox" />
            I prefer to work with staff only</p>
            </td>
        </tr>
      </table></td>
    </tr>
    <tr>
      <td style="padding: 3px; border-bottom: solid #333 2px;">Do you have specific skills you would like to share or develop?<br />
      <textarea name="textfield17" cols="90" id="textfield17"></textarea></td>
    </tr>
    <tr>
      <td style="padding: 3px; border-bottom: solid #333 2px;">Do you have any interests you&rsquo;d like to explore?<br />
      <textarea name="textfield18" cols="90" id="textfield18"></textarea></td>
    </tr>
    <tr>
      <td style="padding: 3px; border-bottom: solid #333 2px;">Do you have previous volunteer experience? Please describe, including organization names:<br />
      <textarea name="textfield19" cols="90" id="textfield19"></textarea></td>
    </tr>
    <tr>
      <td style="border-bottom: solid #333 2px;"><table width="796" border="0" cellspacing="0" cellpadding="0">
        <tr>
          <td style="padding: 3px; border-right: solid #333 2px;">When are you available to volunteer? (Days, Times)<br />
            <textarea name="textfield20" cols="33" id="textfield20"></textarea></td>
          <td style="padding: 3px;">How often do you want to volunteer? (Ex.: once a month/twice a week/one-time events?)<br />
            <textarea name="textfield21" cols="50" id="textfield21"></textarea></td>
        </tr>
      </table></td>
    </tr>
    <tr>
      <td style="padding: 3px;">How did you hear about volunteer opportunities at the YMCA?<br />
      <textarea name="textfield22" cols="90" id="textfield22"></textarea></td>
    </tr>
  </table>
  <br />
  <strong>STUDENT VOLUNTEERS</strong>
<table width="796" border="0" cellspacing="0" cellpadding="3" style="border: solid #333 1px;">
  <tr>
    <td>Are you looking to fulfill a school requirement, or will you receive school credit for your service?
      <input type="checkbox" name="checkbox27" value="checkbox" />
      Yes
      <input type="checkbox" name="checkbox28" value="checkbox" />
      No<br />
      <table width="792" border="0" cellspacing="0" cellpadding="0">
        <tr>
          <td>IF YES, name of school:
            <input name="textfield23" type="text" id="textfield23" />
            <br />
            Number of Hours needed:
            <input name="textfield24" type="text" id="textfield24" /></td>
          <td>Are you interested in Service-Learning opportunities?
            <input type="checkbox" name="checkbox29" value="checkbox" />
            Yes
            <input type="checkbox" name="checkbox30" value="checkbox" />
            No<br />
            Deadline to Complete Hours:
            <input name="textfield25" type="text" id="textfield25" /></td>
        </tr>
      </table></td>
  </tr>
</table>
<br />
<table width="800" border="0" cellspacing="0" cellpadding="3" style="border: solid #333 2px;">
  <tr>
    <td align="center"><strong>We do not offer opportunities to complete community service hours.</strong><br />
      <br />
      <br />
      <input type="submit" name="Submit" value="Submit" /></td>
  </tr>
</table>
<br />
</form>
</body>
</html>

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