Survey - Volunteer waiver acknowledgement - Myeloma Canada

Volunteer waiver acknowledgement

By completing and submitting this form, you confirm that you have read and understood the terms of the volunteer waiver. Your electronic submission serves as your official signature and indicates your agreement to the conditions outlined, including those related to safety, responsibilities, and liability.
If you have any questions before proceeding, please contact us at contact@myeloma.ca or 1-888-798-5771.

Personal information

Field Is Required First

Field Is Required Last

Field Is Required City/Town:

Field Is Required Province / State:

Field Is Required Email:

Field Is Required Phone Number:

Are you 18 years old or older?

Yes
No

Emergency contact name

Emergency contact number

Emergency contact's relationship to you

Do you agree to the terms?

Yes
No

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