Please complete this application form if you are interested in becoming a member of the Patient and Family Advisory Council at Our Lady of Lourdes Memorial Hospital. Once you complete the form, click the submit button at the bottom.


Name and address


Care received at Lourdes


Why would you like to be a member of the Council?


Special interests/experiences


Other helpful information

We believe the Patient and Family Advisory Council should reflect the diversity of the population that Lourdes serves. In light of this, please share any information that you think would add to the diversity of our Council.


Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.


Volunteer Agreement

I understand that I am applying to serve in a volunteer capacity without contemplation of pay for the services I am providing.