Oxnard Medical Camp- Sunday October 15, 2017 Sathya Sai Baba International Organization
To Volunteer
First Name *
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Last Name *
Mandatory
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City
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State
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E-mail Address *
Mandatory
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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.
Your answer
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
Choose from the list
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 camp before?
Do you speak Spanish?
Languages spoken other than English
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Would you participate in packing grocery items/set-up for the medical camp on October 14th?
I consent to my photo being used for appropriate camp purposes/articles.
Questions/Comments/Concerns
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