Thank you for your interest in becoming a volunteer

Please answer all questions to the best of your ability, read the acknowlegement and hit 'submit'. Your application will be submitted to Breast Friends electronically and Breast Friends will contact you .

Your full name:

Your email address: (e.g.: you@aol.com

Your home phone number (with country, city, area code): 

Your phone number: Work:

Cellular:             Pager:

Fax:
 

Best Time to Call:

Which Number:

24 Hour Telephone Support Network

Available for Telephone Support?Survivors Only Please

If Yes, tell us exactly when you are available. (List Days/Evenings of
the week/weekend you can be scheduled (example:) I am available Monday,
Wednesday Thursday-days; Tues -Evenings; Saturday-days

Home Visits:

Available for Home Visits?Please let us know if you are not available at any time

Transportation Services:

Available for Transportation Services?Please let us know whether you are available for transportation services (own vehicle required) or any times you are NOT available for transportation services.

Clerical/Office:

Available for Clerical?Please let us know if you are available days, evenings, weekends or any time                        

Please note: Volunteers who sign up for in-home visits and/or transportation services(including companionship during chemotherapy) will be paid $.31 per mile for travel costs plus parking costs..

Tell us why you wish to become a Breast Friends volunteer?

What words did you hear during your recovery that helped you the most?

How did you cope with your own experience? Did you seek a support network of some kind? Did it provide what you needed?

Are there any special areas of interest or individual methods you used during your recovery process that you would like to share with a caller?

Would a family member (husband,teenage/adult child, parent,sibling) be willing to participate in our peer support program and talk to a caller's family member should they need support.

Name: Relationship to you:

I acknowledge that as a Breast Friends volunteer I an only offer peer support, I will not offer medical advice,interpret medical tests or findings, contradict, disagree or otherwise comment on treatment or recommendations made by a caller's physician. I will not refer a caller to a physician unless the caller indicates specifically that she does not have a physician or is requesting a referral for a second opinion. Nor will I comment or render an opinion about the caller's choice of physician. Furthermore, I will not use Breast Friends or its callers as a forum to express political or religious views, endorse a particular medical treatment, product or service or to conduct business activities or engage in any type of solicitation for my own part.

I acknowledge that my relationship with Breast Friends is strictly voluntary, and that both parties have the right to terminate said relationship at any time without cause or prejudice. All information received is kept strictly confidential and will not be distributed in any way.

By submitting this form, I acknowledge that I have read and understood the above acknowledgement.
 
 
 

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Meet the Director

Email: Breast Friends.Org

Write to:

Breast Friends Inc.
180 Allen Road  Suite 204-South
Atlanta, GA  30328
Phone:
(404) 843-0677  (support line)
1(888) 718-3523 (National toll-free)
(404) 843-0839  (business line)
(404) 843-2602  (fax)