Medical Outreach Volunteer Sign up Oct 21, 2017

Location:
Event: Fresno City College - Cafeteria
Address: 1101 E University Ave., Fresno, CA 93741
Time: 9AM - 3PM

Patient starts register at 8AM

*Vegetarian Lunch will be provided.*

Check in time:
Volunteer: 7:00 AM
Register Nurse: 7:30 AM ( Triage start at 8AM)
Providers: 8:30 AM

Volunteers need to show up before the event start for orientation. Please refer to "Check in Time"

General Information
Last Name
Your answer
First Name
Your answer
Contact Number
Your answer
Email
Your answer
Are you a first time volunteer?
Emergency Contact Information
If there is an emergency, please indicate the first name and phone number of the person we should contact.
Emergency Person First Name
Your answer
Emergency Person Last Name
Your answer
Emergency Person Contact Number
Your answer
Are you Medical Professional?
License MD,NP,PA,RN,MA,DDS,RDH,RDA,RPH,OD,DO,DC, LAc.,EMT,X-ray Tech
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