Volunteer Ambassador application form

Thank you for your interesting in becoming a Volunteer Ambassador with Dementia UK. Please fill out the form below and we’ll get back to you shortly!

Volunteer registration form

Title*
Name*
First Last
Email*
Address*
Street Address Address Line 2 City Postal code Country
Phone
Keeping you updated
It’s only with support from kind people like you that we can be there for families living with dementia across the UK. We would like to keep in touch and update you with the latest behind the scenes news, including the incredible difference our specialist Admiral Nurses make, and how you can help us to continue our long term work by fundraising and volunteering for us.
Your personal details will be treated as confidential and kept for no longer than necessary. If your application is accepted the information you provide on this form will become part of your volunteer records which will be used to plan and record your involvement as a volunteer.
- Yes, I'd like to receive email updates
- Yes, I'd be happy to receive updates by phone
- Yes, I'd like to receive text message updates
- No contact via post please
If you would like to change how you are contacted by us, simply contact our Supporter care team 0300 365 5500 or email at supportercare@dementiauk.org
For further information about how we protect and use your data please see our privacy policy at www.dementiauk.org/privacypolicy.
Skills and Availability
Why do you want to be a Volunteer Ambassador?*
Max 1000 characters
How do you meet the criteria outlined in role description?*
Max 1000 characters
How much time can you commit per month to this role?*
- Monthly
- Fortnightly
- Weekly
- More often
Please provide any further information in support of your application
Max 1000 characters
References
Please provide details of two referees. Your referee can be a friend, colleague or neighbor but not a family member. Each referee should be willing to provide us with a reference and should have known you for at least twelve months.
Referee 1
Title*
Name
First Last
Referee 1 - Contact details*
Street Address Address Line 2 City Post Code Country
Phone
Email
Referee 2
Title*
Name
First Last
Referee 2 - Contact details*
Street Address Address Line 2 City Post Code Country
Phone
Email
Additional Information
Please tick to confirm that you are over 18
- Yes, I am over 18
Do you hold a driving licence?
Do you have the right to volunteer in the UK?
Do you have any special requirements or health issues?
If yes, please give us more details about your requirements:
Name
This field is for validation purposes and should be left unchanged.

Volunteer Ambassador application form

Volunteer registration form

Keeping you updated

Skills and Availability

References

Referee 1

Referee 2

Additional Information