Medxcel/TriMedx Application

Multiple Countries

Volunteer

Global Outreach - Restricted

Experienced

Multiple country trip application for TriMedx.

Please ensure your birthdate is entered in the following format: YEAR-MONTH-DATE (total of 8 characters)

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Required*

First Name*

Last Name*

Email Address*

Phone*

Street Address*

City*

State*

Zip Code*

Country*

Birth Date (YYYY-MM-DD)*

Gender*

Nickname*

Marital Status*

If married, what is your spouses name (first and last)?

Current Occupation*

Emergency Contact Name*

Relationship to Emergency Contact*

Emergency Contact Phone Number*

Why do you want to serve with CURE?*

I, along with all members of my family in consideration of the benefits derived, if accepted for a CURE International project, hereby voluntarily waive any claims against the local and international organizations, local officer(s), sponsoring institution(s), and all leaders of CURE International for any and all cases in connection with the activities of the above organization. I have read and agree to all the information outlined in this application and its accompanying documents, including all the disclaimers.

I recognize the risks involved with international travel and will read the pre-trip orientation thoroughly.

I understand that before being placed at a CURE hospital or program, I will be required to authorize a personal background check.* I agree

Please upload a copy of your passport (must be valid 6 months after your arrival date)

Human Check*

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CONNECT YOUR PASSION WITH YOUR PROFESSION!

Who does CURE need?

Medxcel/TriMedx Application

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