Huntington Park Medical Camp                Sunday, July 7, 2019
           
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Volunteer Registration Information
Sathya Sai International Organization
PACIFIC SOUTH REGION 8
First Name
Last Name *
Gender *
Mandatory
City where you reside
E-mail Address *
Mandatory
Primary Phone # *
Mandatory
Alternate Phone #
Is E-mail best way to be contacted?
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Age: If under 18, specify your age
Must be 16+ years to volunteer. Disclaimer: I have parental permission to serve in the camp
I Belong to the Following Sri Sathya Sai Center
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Do you have experience in the healthcare/Medical field?
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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.
Physicians & Dentists
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Physicians & Dentists
Do you have malpractice insurance outside of our work location?
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Physicians Only
What is your specialty?
All Volunteers
 Have you participated in a medical screening camp before?
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Do you speak Spanish?
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Languages spoken other than English
I consent to my photo being used for appropriate camp purposes/articles.
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Questions/Comments/Concerns
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