Corona Medical Camp - Saturday March 9, 2019 Sathya Sai International Organization- Pacific South - Region 8
To Volunteer
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Last Name *
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City
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State
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Email Address *
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Primary Phone # *
Mandatory
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Alternate Phone #
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Is E-mail best way to be contacted? *
Age: If under 18- Specify the age.
Need Parental Permission. Please see the disclaimer section. NOTE: YOU MUST BE 16 TO SERVE ON THE DAY OF THE EVENT, OCTOBER 16th.
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Disclaimer: My Child has parental permission to serve in this camp
If you are attending SSE(Balvikas) program, Choose the center from the list
I belong to the following Sri Sathya Sai Center
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Do you have experience in the healthcare/Medical field?
If yes, What is your professional Medical designation
Important Notice: Medical Professionals should have their medical liability coverage extended via their offices to serve patients directly in one day medical screening . Malpractice insurance is mandatory, except for blood lab participation. participation.
Have you participated in a medical screening event before?
Do you speak Spanish?
Languages spoken other than English
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I consent to my photo being used for appropriate camp purposes/articles.
Questions/Comments/Concerns
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