Peru Application
Thank you for your interest in traveling to Peru with the Wilderness Medicine Fellowship and Sacred Valley Health. The trip dates are Nov 4-14, 2018. Once we have received your completed application we will contact you. If you have questions, please contact Keri Baker at Kbaker@sacredvalleyhealth.org or Klbaker1@carilionclinic.org
Name *
First and last name
Your answer
Email *
Your answer
Phone number *
Your answer
Briefly describe your medical background *
Your answer
Describe your wilderness medicine experience and/or certifications *
Your answer
Briefly describe your experience traveling abroad *
Your answer
Do you speak Spanish? *
Why do you want to join this trip? *
Your answer
There is a possibility of an optional backpacking trip at the end trip. If you are interested in joining, please describe your backpacking experience
Your answer
Prior to departure there will be approximately 6 hours of pre-departure classes. In order to participate on this trip attendance is mandatory. Do you agree to attend the required classes? *
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