CACCC Volunteer/Member Application
____ New ____ Updated

Date __________________


I would like to join CACCC as a Member Volunteer


Full Name
(include any degree/title) ____________________________________________________

Chinese Name (if applicable) ____________________________________________________________

Home Address _____________________________________________________________________________

Email Cell Phone

Home Phone Business Phone

Emergency Contact Contact Phone ________________

Language(s)
Spoken English Mandarin Cantonese Taiwanese Other
Written: English Chinese Other

How did you learn about CACCC? ___________________________________________________

Volunteer Area(s) of Interest:

Events Fundraising Membership Photo/Video/Design
Bereavement Support* Heart to Heart™ Café* Patient Visit*
Interpretation* Translation* Speakers Bureau* Suicide Prevention*
Warm Line* Website* Other ________________________________________


Optional (for statistical purposes only):
Ethnic Group Current Employer ________________________________

Print & Mail completed application to:

Chinese American Coalition for Compassionate Care
P.O. Box 276 Cupertino, CA 95015

Or

Email to:
admin@caccc-usa.org

*Training required
U
WHO WE ARE
The Chinese American Coalition for Compassionate Care, the only coalition in the nation devoted to end-of-life concerns in the Chinese community, is an active working coalition of 48 Partner Agencies and over 1,300 individual members.

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CONTACT US
EMAIL US (admin@caccc-usa.org)

TOLL FREE NUMBER
(866) 661-5687
(Leave a message and someone will contact you)

©CACCC, 2006