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Name of Organization:
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Web Address (e.g. http://www.internationalhealthvolunteers.org):
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Address:
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City:
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State/Province:
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Zip:
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Country:
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Phone:
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Fax:
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Primary Contact (e.g. John Smith):
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E-mail Address (e.g. admin@internationalhealthvolunteers.org):
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Organizational Description/Profile
Please answer as much as possible.
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Organizational Mission Statement:
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Organizational commitment to train local personnel to perpetuate health promotion activities:
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Consistent and prolonged investment with a particular region, clinic, or hospital:
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Specialities of volunteers needed:
Keep CTRL pressed to select multiple
If not in a list please write below
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Regions/geographic locale of most projects:
Keep CTRL pressed to select multiple
If not in a list please write below
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Religious affiliations (if any):
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If not in a list please write below
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Additional comments:
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