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Become a Volunteer

 

For more information about becoming a volunteer, complete and send form below.

REQUIRED INFORMATION*

1.

Why are you interested in volunteering with WHA?

Screening Colonoscopy Teaching Program
We are looking for volunteer gastroenterologists and nurses with experience in colonoscopy to join our medical teaching team. The teaching mission will be of one week duration. 

Medical & Dental Mission
We are looking for medical and dental health professionals and support staff. Support staff can be of any background. The team is especially interested in individuals with experience in news media, journalism, website experience, and videography. The work and travel are demanding and you will be immersed in the local cultures. 

Rapid Disaster Respond Program
We are looking for health professional and non-health professional volunteers with all background experience.  

If other, please specify:

2. Your Contact Information
*Name
Title*FirstMiddle
Initial
*LastSuffix
Professional Suffix If other, please specify:
*Email
*Street 1
Street 2
*City/State/Zip
*City *State or Province *Postal or Zip Code
*Country
*Phone *Phone Type
Yes, I would like to receive e-mail from WHA.

3.
Your Profession
4. Your medical or dental specialty, if applicable:
5. In which states are you licensed to practice medicine or dentistry?
6. Are you interested in volunteering in a particular country or region?
No
Yes, please specify
7. Do you have international travel experience?
No
Yes, please specify
8. Have you ever participated in a medical or dental mission?
No
Yes, please list dates, sponsoring organization, location of mission:
9. Please list your foreign language abilities and degree of fluency:
10. Please indicate your interest in assisting the WHA program with the following areas (check all that apply):
working with WHA administrative team
fundraising effort
promotional effort
overseas medical mission
overseas dental mission
U.S. medical mission
helping with foreign diplomacy
have equipment to donate
have supplies to donate
monetary donation
Other, please specify
11. How much notice would you need to serve on a mission?

12.
How did you learn about WHA?
If other, please specify:
13. *Age:  

Do you have any physical limitations or medical conditions which would impair your ability to participate fully in a medical or dental mission?
Word Verification:


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