Fibroid Champion / Volunteer FormFull Name *Date of BirthGender *Select your genderFemaleMalePrefer not to sayOtherCountry *Enter your countryRegion / City / Town *Enter your region / city / townPhone / WhatsApp Number *Enter Phone / WhatsApp NumberEmail *Background & SkillsCurrent Occupation / Role *Organisation (if any)Have you worked on health or women’s rights projects before? *YesNoIf yes, briefly describe your experience *Relevant skills (tick all that apply) *Health professional (doctor, nurse, midwife, etc.)Public speaking / teachingCommunity mobilisation (church, mosque, women’s group, youth group)Social media / content creationCounselling / peer supportAdministration / fundraisingTranslation / local language supportOtherIf Other, please specifyInterest in FibFAWhy do you want to be a Fibroid Champion or volunteer with FibFA? *How would you like to help? *Community awareness talksOne-to-one counselling / supportOrganising eventsSocial media advocacyFundraising and partnershipsTranslation / local language supportAdministrative support (data entry, phone calls, etc.)Research supportHow many hours per month can you realistically volunteer? *Please SelectLess than 5 hours5–10 hours10–20 hoursMore than 20 hoursAvailabilityPreferred areas for activities (districts, churches, schools, workplaces, etc.) *Preferred days / times *Weekdays – daytimeWeekdays – eveningsWeekends – daytimeWeekends – eveningsConsentI agree that Fibroid Foundation Africa (FibFA) may contact me about volunteering and store my information securely for this purpose. *YesI am interested in being trained as an official Fibroid Champion when training opportunities are available.YesType your full name as your electronic signature *Date *Register
