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2. Name

   Only first name and last initial will be used.

4. Volunteer Position
5. Years Volunteering with Coquitlam
7. Email Address

   For follow up.

9. Why I Volunteer with Coquitlam
11. My favourite thing about volunteering with Coquitlam
13. My most memorable volunteering experience with Coquitlam
15. Collection and Use of Personal Information

    By submitting this form you are consenting to the collection, use and disclosure of your personal information between the City of Coquitlam and our Service Providers (CivicPlus, Upaknee, Tri-City News etc.). Your information is collected for the purposes of Volunteer Week in accordance with the Freedom of Information and Protection of Privacy Act. Volunteers will have the information they provided posted on social media, the City website, on posters in City facilities and in the newspaper. For questions regarding the collection and use of your personal information, please email Community Services.

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17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

* indicates a required field