Huntington Park Medical Camp Sunday, July 7, 2019
Volunteer Registration Information
Sathya Sai International Organization
PACIFIC SOUTH REGION 8
First Name
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Last Name *
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Gender *
Mandatory
City where you reside
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E-mail Address *
Mandatory
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Primary Phone # *
Mandatory
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Alternate Phone #
Your answer
Is E-mail best way to be contacted?
Age: If under 18, specify your age
Must be 16+ years to volunteer. Disclaimer: I have parental permission to serve in the camp
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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.
Physicians & Dentists
Next 2 questions
Physicians & Dentists
Do you have malpractice insurance outside of our work location?
Physicians Only
What is your specialty?
Your answer
All Volunteers
Have you participated in a medical screening camp before?
Do you speak Spanish?
Languages spoken other than English
Your answer
I consent to my photo being used for appropriate camp purposes/articles.
Questions/Comments/Concerns
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