Science Volunteer Request Form
The Research Operations and Professional Membership teams are pleased to help identify science volunteers for your local and regional activities. We support your effort to bring science to your events and meetings. Please complete the below form with as much detail as possible to help us find the most appropriate volunteer for your needs. We request that you submit the form at least 30 days in advance to allow for any vetting.
1. Staff Name
*
First Name
Last Name
2. Staff Email
*
example@example.com
3. Day of Event Contact Info (including name and cell phone #)
*
4. Staff Department
*
Advocacy/Gov't Relations
Communications
Multi-Cultural Initiatives
Development
Leadership
Youth Market
Other
5. Region
*
Eastern States
Midwest
Southeast
SouthWest
Western States
National Center
6. Event Name
*
7. Event Type
*
Community Event
Heart Ball/Gala
GRFW Event
Heart Walk/Field Day
American Heart Challenge/Kids Heart Challenge
Lobby Day
Leadership Meeting
Other
8. Audience Type
*
AHA Board
AHA Staff
AHA Non-Board Volunteers
Community
Local Government
Students
9. Anticipated # of Attendees
*
10. Date of Event (request should be submitted at least 30 days in advance)
*
-
Month
-
Day
Year
Date
Sending Date
-
Month
-
Day
Year
Date
11. Time of Day Volunteer Needed (check all that apply)
*
Morning
Early Afternoon
Lunchtime
Late Afternoon
Evening/Dinner
Late Night
Other
12. Is this a sponsored event or meeting with a sponsor? If so, who are the main sponsors?
*
13. Are you requesting someone to speak? If so, for how long?
*
14. Is this event virtual or in-person?
*
Virtual
In-person
15. Event Address (including venue name, street address, city, state)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
16. Event Attire
*
Event T-shirt
Casual
Business Casual
Business
Cocktail
Formal
17. Are you requesting a tour of a facility or lab?
*
Yes
No
Maybe
Other
18. Are you requesting a visual presentation, including slides, video or poster presentation? If so, please indicate type of visual and if the needed technology will be available.
*
19. Type of Volunteer Requested (check all that apply)
*
Currently Funded Researcher
Previously Funded Researcher
Early Career Science Volunteer
Tenured Career Science Volunteer
Cardiovascular Specialist
Neurology Specialist
Other
20. Any specific areas of focus or specialties you are looking for in the requested volunteers?
*
21. Please provide any additional information that will be helpful in identifying a science volunteer for your event.
*
Submit
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