Untitled Document

WalkItUp! Kanawha County
Volunteer Information Form

Name:

Title/Position:

Organization:

Address:

City:

County:

State:

Zip Code:

Work Phone:

Other Phone:

Email Address:

Website:

Please answer the following questions to help better identify the goals and needs of the workgroup members:

1. If you could accomplish one thing in regards to physical activity in Kanawha County, what would that be?

2. Are you currently working for or with an organization which would be interested in supporting a county-wide physical activity campaign?
Yes No Don't Know 3. Are you affiliated with other individuals, organizations or civic groups that would be interested in our campaign? If yes, please list along with contact information?
4. I would be interested in serving on one or more of the following committees: Physical Activity Opportunities: Guide, walking clubs, assessments, etc Community Events: Walking campaigns, marathons Fundraising: Planning and funding for marketing ideas
5. The best day/time of the week for me to attend a meeting is:
Monday Tuesday Wednesday Thursday Friday	8AM - 10AM 10AM - 12PM 12PM - 2PM 2PM - 4PM
6. We are trying to identify key contacts in areas throughout the county to facilitate activities in those areas, please select which areas you live or work in that you would like to be involved:
Belle Cabin Creek Cedar Grove Cross Lanes Downtown Dunbar East Bank	East End Elkview Kanawha City Marmet Nitro Sissonville So Charleston	South Hills St. Albans West Side Other: