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Mid America Chapter Volunteer Form

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Question - Not Required - Please tell us your connection to multiple sclerosis:

Question - Not Required - Please indicate which of the following activities you are interested in:

Question - Not Required - I have the following skills/experience that I am willing to utilize:

Question - Not Required - I have the following certifications/licensing that I am willing to utilize:



Volunteer Consent Form

CODE OF CONDUCT Based on the National Multiple Sclerosis Society’s “code of conduct”, I understand that as a representative of the National MS Society, I must always conduct myself in a fashion that does not jeopardize the image of the Society.  To the degree I may be given access to the identity and details of persons with multiple sclerosis and their families, I will safeguard such information in strict confidence.

EMERGENCY MEDICAL TREATMENT AUTHORIZATION:  I hereby consent and permit emergency treatment in the event of injury or illness while participating in a Mid America Chapter of the National Multiple Sclerosis Society event or program. 

MEDIA RELEASE:  I hereby grant permission to the National Multiple Sclerosis Society and the Mid America Chapter to use my name and any photograph, likeness or image taken of me during the event or program in any promotional materials, publications or via the website. 

RIGHT OF REFUSAL/DISMISSAL:  It is my further understanding that the National Multiple Sclerosis Society reserves the right to refuse or dismiss anyone that may cause any disturbance or hindrance in any manner that could jeopardize the safety of oneself or others.

TRANSPORTATION:  It will be my sole responsibility to obtain the necessary mode of transportation to perform these responsibilities.  If for whatever reason I am unable to perform as agreed, I will advise the Mid America Chapter staff immediately.

ALCOHOL AND DRUG USE Chapter policy prohibits the use of alcohol or other non-prescribed drugs during working hours by its volunteers.  No volunteer who has been drinking, or is under the influence of non-prescribed drugs, will be permitted to work in any Chapter office or at Chapter sponsored events and programs.


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