Help others ---- Join us a a volunteer!
It has been said that helping others is one of the greatest therapies of all times.

Here is an opportunity to help promote COPD awareness and to help
other COPDers learn to deal with the daily problems of living with COPD

All of our call center Associates are COPDers
who have received additional training to equip them with the knowledge and skill to help others.

If you have COPD and would like to apply or learn more, please fill in the form below

NAME:

ADDRESS:

CITY: STATE: ZIP CODE:

PHONE: FAX: Other Phone:

Email:

To be able to log into call center and the support web, you will need the following:

A PC with Windows 2000, Win XP, or higher
Microsoft Internet Explorer
High Speed Internet connection (DSL, Cable etc)
A second phone line (or be willing to devote your primary
      phone line exclusively to inbound call center activities
      during your on duty hours - Call waiting etc turned off -
      please note: Vonage will not work)

Do you have access to all of the above? Yes       No

Are you available for a minimum of 8 hours per week (2 four hour shifts) between 9am and 9pm (eastern time zone) for the information call line?
Yes No

How long have you been diagnosed with COPD?
Do you have any disability that will adversely affect your ability to work the information line?

Why do you feel you would make a good phone associate?

Comments: (include any explanation needed for items above)

Best day and time for us to call for additional information? (Eastern)

How did you hear about us?