Up Close Journey Registration

Multiple Countries

Volunteer

Global Outreach - Restricted

Mid Level

We are excited to have you join us on a CURE Up Close Journey. The information we collect here will help us better serve and prepare you and the field for this visit.

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*

Current Occupation*

What excites you most about visiting a CURE hospital?

Emergency Contact Name*

Relationship to Emergency Contact*

Emergency Contact Phone Number*

Would you like CURE to assist with round trip flights from the US to the CURE Up Close Journey location?

If yes, what airport(s) would you like to depart and return to?

What size T-Shirt do you wear?

I, along with all members of my family in consideration of the benefits derived, 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 (picture page and make sure you have at least 6 months on your passport beyond your travel dates)

Human Check*

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CONNECT YOUR PASSION WITH YOUR PROFESSION!

Who does CURE need?

Up Close Journey Registration

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