MSHA Conference Volunteer Form

March 24-26, 2011

Ritz-Carleton Hotel≈Dearborn, Michigan

Please complete this form and return to the MSHA office along with your MSHA Conference Registration Form.

●Willing and able to volunteer your time at the conference
●A MSHA Student Member (registration is just $15.00 for MSHA Student members but they must commit to a volunteer assignment)

Most volunteer assignments will be for approximately 1-2 hour time commitments. You will receive notification of your assignment prior to conference.

Please mark appropriate boxes:

Yes, I can volunteer. I would like to:

/  /Moderate a Session / / Aud / / Speech / / No preference.  Please respond by January 25, 2011!
/  /Work a shift at the Registration Table (see shifts below)
/  /Help out at a Forum (Public School or Medical Speech-Language Pathology) on Saturday (collect lunch tickets, distribute materials, etc.)
/  /Help with a Short Course (collect tickets, distribute materials)

Name:____________________________________________________________________________________

Address:_______________________________________________

City/State/Zip:____________________

Phone: ______________________

Email Address: __________________________________

/ / Student: University:

Please circle the time you are available:

Thursday, March 24

3:00-5:00 PM

4:30-6:30 PM

Friday, March 25

7:30-9:30 AM

9:00-11:00 AM

10:30-12:30 PM

12:00-2:00 PM

1:30-3:30 PM

3:00-5:00 PM

Saturday, March 26

8:00-10:00 AM

9:30-11:30 AM

11:00-1:00 PM

12:30-2:00 PM

1:30-3:30 PM

Thanks for your help!  You will receive a confirmation in writing.  Please return this form as soon as possible, but no later than March 15, 2011 (January 25th for Moderators).

Return to: MSHA ~ 790 W. Lake Lansing Rd. Suite 500-A
East Lansing, Michigan 48823 Fax: 517/332-5870 email: msha@att.net
Website: www.michiganspeechhearing.org