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"WDD" Partner NGO /
Volunteers Sign Up Form
“Life’s most persistent and urgent question is, what are you doing for others?”
– Martin Luther King, Jr.
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* Indicates required question
Are you an NGO or an organization looking at partnering with us to save lives?
*
Yes
No
I work in an organization and I think we can provide some of the equipments needed
I am a professional, I would love to volunteer for few hours?
Other:
First Name
*
Your answer
Middle Name
Your answer
Last Name
*
Your answer
Preferred mode of contact
*
Choose
E-mail
Phone (sms)
Phone (call)
Phone (WhatsApp)
Phone (voice message)
Functional Phone Number
*
Your answer
E-mail address:
*
Your answer
If an organization looking at partnering with us, what is the name of your organization?
Your answer
Where is this organization's head office located?
Your answer
Where do you currently work?
*
Your answer
Are you a student, but you can add value to what we would be doing on this day?
*
Yes
No
I am not a student, I am a professional, I currently work
Other:
Discipline?
Your answer
Level?
Your answer
Profession
Doctor
Pharmacist
Medical Laboratory Scientist
Registered Nurse
Vocational Nurse
Clinical Nursing Assistant
Other:
Clear selection
Do you think you would be available for the World Diabetes Day Slated for November 13th and 14th, 2022?
Your Availability?
10:00am - 12noon
11:00a.m - 1:00pm
12:00noon - 2:00p.m
1:00p.m. - 3:00p.m
2:00p.m. - 4:00pm
Clear selection
Your Current Location (State) or where would you be on the 13th or 14th of November, 2022?
Choose
Lagos State
Ibadan, Oyo State
Akure, Ondo State
Kano, Kano State
Oshogbo, Osun State
Minna, Niger State
FCT, Abuja
Jos, Plateau State
Kaduna, Kaduna State
Adamawa, Yola State
Abeokuta, Ogun State
Lokoja, Kogi State
Katsina, Katsina State
Maiduguri, Borno State
Ado, Ekiti State
Ilorin, Kwara State
Benin, Edo State
Gender
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Male
Female
Submit
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