Guerrero 2020 Spring Eye / Dental Clinic

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www.guerreroclinic.org

Volunteer Information

First Name *

Please Enter name as it is found on your passport

Middle Name

Please Enter name as it is found on your passport

Last Name *

Please Enter name as it is found on your passport

Preferred First Name (If different than legal name)

Date of Birth *

YYYY

Gender *

Male

Female

Cell Phone Number *

xxx-xxx-xxxx

Email Address *

Citizenship *

Mexico

Other:

Required

Passport Issuing Country *

Passport Number

Required if electing option for Clinic to book your airfare and you will fly through Dallas on American Airlines

Passport Expiration - Leave blank if you do not currently have a passport.

Must have a passport that expires at least 6 months after return from the clinic. You can generally get a passport quickly but it can be expensive and not guaranteed that it will arrive in time. The clinic will not refund your money if we purchase a ticket for you and your passport does not arrive in time.

YYYY

Do you have any physical limitations that will impact your ability to volunteer at the clinic? *

Please keep in mind the clinic is in rural Mexico at an elevation of 7,000 ft

Other:

Do you have any dietary restrictions? *

People with various restrictions successfully attend our clinic. However, we do not promise that we can accommodate all diets. Please let us know potential challenges so we can help you decide whether you can eat with us.

Other:

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