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Volunteer registration sheet
VOLUNTEER APPLICATION Health Education Project
Imp Pierre ville #5, Santo 12, Cx-Des-Bqts, P-Au-P, Haiti.
Email:
healtheduproject@gmail.com
, Phone: (509) 474-3684
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Email
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Name
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Address
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Email
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Occupation
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Interests
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In which area would you like to volunteer with us?
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Mobile Clinic
Community outreach
Training
School teaching
Water Project
Construction project
Other
Languages Spoken
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Have you ever been convicted for violation of any laws, traffic or otherwise?
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Do you have any physical condition that may limit your activities?
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Emergency Contact
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Dates Available to Voluneer
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YYYY
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