Please complete this form if you are interested in becoming a member of Assistance League of Arcadia. Please note *required fields. Once you complete the form, click the continue button at the bottom.

Name and Contact Information

First name:

Last name:

Title:

Street 1:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Cell phone:

OK to call me here

Email address:

Gender:

Marital status:

Organization

Please indicate the organization you are applying for: Assistance League of Arcadia Chapter, Las Alas Auxiliary, or leave blank if not sure.
*Please note: Assisteeens Applications are only available during the month of February and are a separate application.

Chapter:

Las Alas:

Professional Experience

Please list professional experience, special skills, and/or training (employers and positions held if applicable):

Employer name:

Work phone:

OK to call here

Volunteer Experience

Please list volunteer experience (organizations and positions held):

Criminal Offenses*

Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? (Convictions for marijuana-related offenses that are more than two years old need not be listed.) If yes, state nature of the crime(s), when and where convicted and disposition of the case.*

Hobbies, Interests, Special Talents

Please list:

Affiliations

Please list members of Assistance League of Arcadia or Las Alas that you know:

Emergency Contact Information

This information will only be transferred to our data base if you join. It is important we have your emergency contact information in case of a medical or other emergency while volunteering.

First name:

Last name:

Home phone:

* OK to call here

Work phone:

OK to call here

Cell phone:

Relationship:

Volunteer/Membership Agreement

As a community volunteer/member of Assistance League, I will consider all information regarding recipients of Assistance League programs confidential. I shall maintain conduct that enhances the image and reputation of Assistance League and does not cause it embarrassment; behaving in a civil manner; supporting the harmony, mission and welfare of the organization. The Board of Directors has the right in its sole and absolute discretion to terminate service of a volunteer/member who, the Board determines has not complied with the responsibilities and standards of membership.

I Agree