Awka Union USA & Canada, Inc - VOLUNTEER APPLICATION FORM

AWKA UNION USA & CANADA

INTERNATIONAL MEDICAL MISSION, INC

Volunteer Application Form

6We are looking for volunteers with varying skills to help this Mission; including medical, administrative and marketing personnel. You may not have to fly to Awka to help with this Medical Mission but we can still use your help, you can donate materials and funds to support this mission.
To be added to the volunteer list, please fill out this short form below.

AVAILABILITY: MISSION DATES - MAY 6 - 11, 2018
LOCATION: AWKA, ANAMBRA STATE, NIGERIA

Our Policy
It is the policy of this organization to provide equal opportunities without regard to race, color, religion,
national origin, gender, sexual preference, age, or disability.
Thank you for completing this application form and for your interest in volunteering with us.

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Medical Mission Volunteer Application

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Name: *

Street Address *

City, State, ZIP: *

E-mail address: *

Home Telephone *

Work Telephone *

Administration

Field Work

Fundraising

Donation - Supplies and Funds

Phone Bank

Newsletter Production

Medical - (Choose one) Physicians, Physician Assistants/Nurse Practitioners --->

Medical - (Choose one) Pharmacists -->

Medical - (Choose one) Nurses, other medical staff please specify.-->

Special Skills or Qualifications Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports.-->

Previous Volunteer Experience Summarize your previous volunteer experience -->

Person to Notify in Case of Emergency. Name, Address, Home Phone, Work Phone, Email Address *

Captcha (spam protection code) *

Note: Fields marked with * are required

Agreement and Signature
By submitting/sending this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

NOTE: You may not have to fly to Awka to help with this Medical Mission but we can still use your help: you can donate materials and funds to support this mission.

VOLUNTEER APPLICATION FORM

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