CATANDUANES INTERNATIONAL ASSOCIATION, INC
5th Medical Mission
Catanduanes, Philippines
January 7th - 15th, 2005
SURVEY FORM FOR ALL VOLUNTEERS
Name:
Address:
City:
State:
Zip:
Telephone:
E-Mail:
Profesion:
How many will be travelling with you?
Please indicate their names, Age, Sex:
Name:
Age:
Male
Female
Name:
Age:
Male
Female
Name:
Age:
Male
Female
Name:
Age:
Male
Female
Name:
Age:
Male
Female
Are you planning to stay with relatives (if any) during the mission?
Yes
No
Would you like to be housed at a place designated by the association?
Yes
No
Would you like to have a reservation at the Westin Hotel in Manila upon arival? (
Westin Hotel want the reservation confirmed by October 30, 2004
)
Yes
No
Will you be attending the get-together/briefing on Jan 7, 2005 at the Westin?
Yes
No
On the trip to Virac from Manila would you prefer to take:
Commercial plane
Bus/Ferry Boat
Army Plane (if available)
I'm going on my own
Here are some of the committees to guide you where you will best serve the mission.
Please check your preference:
Physicians
Medical
Surgery
Gen. Medicine
Gen. Surgery
Specialty (Please Specify)
Speciality (Please Specify)
Nursing
Nursing Speciality
Nursing Triage
Ancillary
Others
Other Health Professionals
Pharmacy
Med Tech
Therapists
X-Ray
Dental Service
Others
Working Committees
Finance
Housing
Statistics
Public Relations
Transportation
Soup Kitchen
Fund Raising
Elite Repeat Clothing Distribution
Photography/Documentary
Support Services
Balik-Catanduanes Program
Note:
All Officers, Regional Vice-Presidents and Team Leaders must keep copies of all enclosures for their guidance/reference. Please make copies for distribution to all willing volunteers. The earlier you submit the forms the better and well organized our mission will be. Deadline for submission of applications will be June 2004 as we need to comply with so many Philippine government requirements to conduct the mission.
THANK YOU FOR YOUR COOPERATION.
