PR Medical Volunteers Form
Thank you for your interest in volunteering to help with the medical needs in Puerto Rico.
Please send copies of all certifications and credentials to
NOTE: Please be patient while we review your information as we are all volunteers. Please feel free to email us at for questions.
We will not sell or share your information, nor use it for purposes other than relief efforts in Puerto Rico.
Email address *
First Name *
Your answer
Last Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Cell Phone *
Your answer
How soon are you available to travel? *
What level of medical aid are you qualified to perform? (you will be required to send evidence) *
Do you have field trauma, emergency response or disaster recovery experience? *
Are you able find your own transportation to Ft Lauderdale Executive Airport (FXE)? *
Are you able to handle incredibly austere and chaotic/uncertain environments? *
Are willing to work within the organizational structure/follow chain of command? *
Your answer
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