469-375-6500
833-375-6500
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Who
We Are
Mission and Vision
Our Speech Therapy Clinic
Leadership & Staff
Parkinson Voice Advocates
In the News
Contact Us
Education & Events
Patients
& Families
Our Speech Therapy Program
Find a SPEAK OUT!
®
Provider
Daily Online Speech Exercises
eLibrary
Patient Testimonials
Frequently Asked Questions
Speech-Language
Pathologists
SPEAK OUT! & LOUD Crowd Training
Research
Purchase Products
Grant Program
SPEAK OUT!
®
Provider Login
Education &
Events
Parkinson's Webinar
Parkinson's Lecture Series
SING OUT! Virtual Choir
DONATE
Contact Us
Home
Login
Who
We Are
Mission and Vision
Our Speech Therapy Clinic
Leadership & Staff
Parkinson Voice Advocates
In the News
Contact Us
Education & Events
Patients
& Families
Our Speech Therapy Program
Find a SPEAK OUT!
®
Provider
Daily Online Speech Exercises
eLibrary
Patient Testimonials
Frequently Asked Questions
Speech-Language
Pathologists
SPEAK OUT! & LOUD Crowd Training
Research
Purchase Products
Grant Program
SPEAK OUT!
®
Provider Login
Education &
Events
Parkinson's Webinar
Parkinson's Lecture Series
SING OUT! Virtual Choir
DONATE
469-375-6500
833-375-6500
Contact Us
469-375-6500
833-375-6500
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 "Volunteer 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
--- Select ---
Other
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington DC
West Virginia
Wisconsin
Wyoming
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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