Advocate Application

Please review the Advocate responsibilities below, and complete the application.

Click "SUBMIT" at the bottom of the page!

1. Attend the Advocate meeting on the 1st & 3rd Wednesdays of each month at 12:15pmCT.

2. Volunteer a minimum of four hours per month.

3. Track your volunteer hours and submit an online "Activity Log" by the 5^th of each month.

4. Be a role model to others with Parkinson's by exercising and taking advantage of the PD resources available to you.

5. Keep your voice strong by doing your SPEAK OUT! exercises and following your speech-language pathologist's recommendations.

Advocate Application

First Name

Last Name

Email Address

Phone

Address

City

State

Zip

When did you complete SPEAK OUT! Therapy?

WHERE did you complete SPEAK OUT! Therapy (Name of Clinic)?

When is your birthday?

Are you retired or still working?

Occupation:

Please list your special skills:

Why are you interested in being an Advocate?

Are you interested in presenting to community groups (e.g. Rotary Clubs, church groups, PD support groups)?

Yes
No

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Please review the Advocate responsibilities below, and complete the application.

Click "SUBMIT" at the bottom of the page!

1. Attend the Advocate meeting on the 1st & 3rd Wednesdays of each month at 12:15pmCT.

2. Volunteer a minimum of four hours per month.

3. Track your volunteer hours and submit an online "Activity Log" by the 5th of each month.

4. Be a role model to others with Parkinson's by exercising and taking advantage of the PD resources available to you.

5. Keep your voice strong by doing your SPEAK OUT! exercises and following your speech-language pathologist's recommendations.

3. Track your volunteer hours and submit an online "Activity Log" by the 5^th of each month.