Tzu Chi Foundation, U.S.A. May 20, 2012 Becoming Independent Santa Rosa, CA Dental Outreach Sign-Up

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

***** Event Sign-up Deadline: 05/06/2012 *****

Event: Becoming Independent Santa Rosa, CA Dental Outreach
Date: Sunday, May 20, 2012
Time: Set up: 7:00 am; Service: 9:00AM - 5:00 PM
Location: Becoming Independent, Main Campus, 1455 Corporate Center Parkway, Santa Rosa, CA

***** Event Sign-up Deadline: 5/06/2012 *****

Contact: Tzu Chi Santa Rosa Service Center at (707) 546-1945 (Daily 10:30- 14:30); Email: tzuchinorthbay@gmail.com and/or
Brother Alan Dang at (408) 888-6278; Email: luan_dng@yahoo.com for any questions:

First Name *

Last Name *

Chinese Name

Address *

Email *

Phone Number *

What dental outreach role would you like to focus on? (Ok and Welcome to click MULTIPLE ROLES) *

Chair Setup / Change-Over

Sterilization

X-Ray Tech

Portable Unit Tech

Tzu Chi Train DA

R.D.A

R.D.H

D.D.S

Oral Hygiene Instructor (O.H.I )

Registration

Flow Control

General Volunteer

Carpool Driver

Other:

Required

Is this your first outreach event? *

Yes

Required

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms