Volunteer Network Sign Up

This questionnaire takes about 10 minutes to complete. Once you submit it, you'll receive an email confirmation with next steps. If you don't receive that email, please contact us at contact@uspainfoundation.org.

1. First Name *This question is required.

2. Last Name *This question is required.

3. Email Address *This question is required. This question requires a valid email address.

4. Please provide your mailing address.

Street Address *This question is required.

Apt/Suite/Office

City *This question is required.

State *This question is required.

Zip *This question is required.

Country

Phone Number

5. What best describes your relationship with chronic pain? (Please check all that apply.) *This question is required.

I am a person living with pain
I am a caregiver, care partner, or loved one of someone living with pain
I am a parent or guardian to a child or teen living with pain
I am a health care professional
Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

7. What is your race or ethnicity? Check all that apply. *This question is required.

White or Caucasian
Black or African American
Hispanic or Latino
Asian
Native Hawaiian or Pacific Islander
Native American, Alaska Native, or Indigenous
Multiracial
Prefer not to say
Other - please specify Please enter an 'other' value for this selection. * This question is required.

8. What is your gender identity? *This question is required.

Please enter an 'other' value for this selection.

9. Do you have any of the following specific conditions? Please review this list carefully and select all that apply. Please note: conditions are listed in alphabetical order. *This question is required.

10. Why do you want to become a U.S. Pain volunteer? *This question is required.

11. How did you hear about U.S. Pain Foundation? *This question is required.

Please enter an 'other' value for this selection.

Volunteer Network Sign Up

Basic contact information