Portal de Salud - Volunteer Registration

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Portal de Salud - Volunteer Registration

Thanks for choosing Portal de Salud/Gracias por escoger a Portal de Salud!

Email *

Last Name/Apellido *

First Name / Nombre *

Telephone/ Teléfono ( Include Area Code/ Incluya el código de area) *

I would like to Volunteer/ Quiero ser Voluntario *

Wellness Program (At least one or more Wednesdays per month/ Al menos un o varios miércoles al mes)

Annual Health Fair / Feria Anual de la Salud

Required

Mark your area of Expertise/ Indique su campo de Experiencia

Physician/Doctor

Nurse/Enfermera

Lab Tech/Técnico de Laboratorio

Medical Assistant/ Asistente Médica

Medical or Nursing Student or Physician Assitant/ Estudiante de Medicina o Enfermeria o Médico Asistente

Student/Estudiante

Medical Interpreter/Interprete Médico

Community Member/Miembro de la Comunidad

Health Educator/Educadora en Salud

Other:

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Please tell us why you want to volunteer with Portal/ Por favor díganos porque quiere ser voluntario de Portal de Salud. *

How did you heard about Portal de Salud/ Cómo supo de Portal de Salud? *

Colleague/Colega

Friend/Amigo

Church/Iglesia

Option 4

Other:

We'll contact you soon/Lo contactaremos pronto.

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