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Bicol Clinic Foundation Volunteer Application Summer Clinic: Nepal 2019
Thank you for your interest in the Bicol Clinic Foundation.

The application and all additional requirements
MUST BE SUBMITTED by:
FEBRUARY 15th, 2019.

The trip is currently scheduled for:
June 2- July 2, 2019.

Please email volunteer@bicolclinic.org if you have any questions or concerns. You may also visit our website at www.bicolclinic.org.

NOTE: Upon submission, all application materials will become the property of the Bicol Clinic Foundation and will not be returned.

Map of Nepal
Personal Information
First Name *
Your answer
Last Name *
Your answer
Gender *
Required
School Email *
Your answer
Personal Email *
Your answer
Please indicate which email we should use for your primary contact. *
Mailing Address *
Street Address, Apt/Unit#, City, State, Zip, Country
Your answer
Primary Phone Number *
(###) ###-####
Your answer
Date of Birth (MM-DD-YYYY) *
Your answer
Country of Birth *
Your answer
Citizenship *
Your answer
Do you have a passport? *
*IMPORTANT NOTE: Those traveling on passports that expire in fewer than six months have increasingly been denied airline boarding or have been detained upon arrival in certain foreign destinations.
Allergy Information and/or Dietary Restrictions *
i.e. specific food allergies, bee stings, etc. or gluten, kosher, vegetarian, etc. If none, type N/A.
Your answer
Health Conditions *
i.e. asthma, diabetes, etc. If none, type N/A.
Your answer
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