Volunteer at The Rose Please fill out fields below to submit your information to the volunteer office. *Indicates required fields First Name*: Last Name*: Address: City:   State: Zip/Postal:   Country: Home Phone*: Cell Phone Work Phone : E-Mail: Education: (Please Check One) High School/GED College Graduate School Name/Location: Major:   Degree: Interests:  Please check all that interest you.   Clerical Special Events   Data Entry Health Fairs   Phone/Calling Out Speakers Bureau   Internet/Research   Availability:  I am interested in volunteering on a:   Temporary/Trial Basis Permanent/Ongoing Basis   Hours I am available each week are:   Less Than 3 Hours 3-5 Hours 5-10 Hours 10+ Hours   Days I would prefer to work are :   Monday Tuesday Wednesday Thursday   Friday Saturday Sunday Special Events   Times I would prefer to work are :   A.M. Hours (9:00-12:00) Afternoon Hours (1:00-5:00) Other

The ROSE Diagnostic Center 12700 North Featherwood Suite 260 Houston, TX 77034 Phone: 281.484.4708 Fax: 281.484.5626 therose@the-rose.org		The ROSE Joan Gordon Center 3400 Bissonnet Suite 185 Houston, TX 77005 Phone: 713.668.2996 Fax: 713.668.3173 therose@the-rose.org

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