We respectfully request that you answer all questions completely and honestly. Please fill out the form only if you are able to appear in person to volunteer. Call 281-536-9591 for more info.

Name (required)

Address (required)

City/State/Zip (required)

Email (required)

Cell Phone (required)

Other

MaleFemale

Date of Birth (required)

Occupation (required)

Describe why you are inspired to volunteer for NMP: (required)

In what capacity would you like to volunteer? (required)

Please select any healing modalities you are certified/licensed to share: (required)
AcupunctureChiropracticMassage TherapyReikiHealing TouchQigongOther Energy Therapist/CounselorYoga (Therapy)Other

Are there any medical or psychological conditions that you feel are important for us to know about? (required)

YesNo

If so, please explain:

Do you have any history of physical illness or limitations that might be aggravated by your volunteering responsibilities? (required)

YesNo

If so, please describe:

Do you have any history of drug or alcohol abuse? (required)
YesNo

If so, please explain:

How did you hear about New Millennium Project?

Are you interested in becoming a board member? (required>
YesNo

BY SIGNING MY NAME BELOW, I, CONFIRM THAT ALL OF THE ABOVE INFORMATION IS CORRECT TO THE BEST OF MY KNOWLEDGE AND THAT I UNDERSTAND THE GUIDELINES AND REQUIREMENTS. IF AT ANY TIME MY CIRCUMSTANCES CHANGE, I WILL INFORM New Millennium Project.