MS150 Acupuncture Tent Volunteer Sign-Up 2015

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Thank you for your interest in volunteering this year! Please complete the information below to register as a volunteer. (This info will only be shared with Sara Erdman and Aimee Van Ostrand, and will not be used for any purposes other than MS150 coordination.)

The event will be held on June 13th, 2015 at the Grand Casino Hotel in Hinkley, MN.

Please make sure you are a part of our Facebook group, that's where we share info & updates on the event. Please check in regularly! https://www.facebook.com/groups/179687788853899/

**Note to Clinic Sponsors**
Thank you for your sponsorship! We are requesting a donation of $50 from clinic sponsors/needlers. Your clinic's name & city will be printed on the backs of our t-shirts, and also on a handout of participating clinics. Your generous donation allows us to purchase supplies, marketing materials & handouts, t-shirts, and covers the tent fee charged by the MS Society. If donations exceed budget, any extra $$ will be donated directly to the MS Society.

Please mail your check to Aimee at the address below by May 15th (Aimee will send you a receipt for your contribution):
Aimee Van Ostrand
3738 Auger Ave.
White Bear Lake, MN 55110

Also, clinic sponsors please email a copy of your clinic's logo to Aimee at avanostrand@ymail.com.

THANK YOU TO ALL VOLUNTEERS! It's going to be a fun day! If you have any questions, please contact one of the organizers:
Aimee Van Ostrand (651-295-1950, avanostrand@ymail.com)
Sara Erdman (612-386-7703, sara.erdman@gmail.com)

Volunteer Information

First Name *

Last Name *

Cell Phone *

Email Address *

Volunteer Role *

Sponsor + Needler ($50 donation required, clinic name/info will be included on t-shirts, printed materials)

Needler

Helper/Greeter

Sponsor only ($50 donation, clinic name/info will be included on t-shirts, printed materials)

License #

All needlers must be licensed in Minnesota.

Do you have Malpractice Insurance? *

All needlers must carry malpractice insurance.

Yes

Shift Selection *

You are welcome to come early for your shift and/or stay late, but we ask that you commit to one full shift during the times listed below. Sara will be providing brief instructions/training during the first 30 minutes of each shift.

Shift 1: 11:30 a.m. - 4:00 p.m.

Shift 2: 3:30 p.m. - 8:00 p.m.

Both Shifts: 11:30 a.m. - 8:00 p.m.

T-Shirt Size

Sizing tends to run 1-2 sizes small, please order accordingly.

Women's Small

Women's Medium

Women's Large

Women's XL

Women's XXL

Men's Small

Men's Medium

Men's Large

Men's XL

Men's XXL

Clear selection

Clinic Information

If you are a Sponsor, please complete this section. Please note that the information submitted will be used on our printed materials.

Clinic Name

Clinic Address

Clinic City

Clinic State

Clinic Zip

Clinic Phone Number

Clinic Email Address

Clinic Website

Additional Information

Can you bring zero-gravity chairs the day of the event, and if so, how many?

We need zero-gravity chairs (must be zero-gravity style, other chairs cannot be used), and we'll need 'em all day. If you have chairs but are unable to stay the entire day, please contact Sara Erdman (sara.erdman@gmail.com) to arrange.

Sorry, cannot bring chairs

1 chair

2 chairs

3 chairs

4 chairs

Other:

Clear selection

Are you interested in receiving CEU credit for your volunteer time?

Yes

Clear selection

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