International Medical Volunteers Association

Volunteer Registration Service

 

The following registry allows medical and medical support volunteers to post information about themselves so that organizations around the world can contact them with possible assignments. There is no obligation or cost.

You will be able to choose to keep certain information (name, address, telephone) from being displayed in the public listing. If you choose this option, the information will be released only to volunteer-seeking organizations.

At the end of this form you will need to choose a password and username. These will allow you later to update the information you enter, or remove yourself from the registry.

 

Name:

Street Address:

City or Town:

State / Province / Country:

Zip / Postal Code:

Email Address (if any):

Telephone:

Fax (if any):

 

Would you like to keep the above information confidential?

Yes, please

No thanks, it is okay to post it

 

Please choose the category(s) which best describe your medical or medical support skills from among the following 5 lists. To choose more than one option from any list - hold down the control key on your keyboard while clicking:

Doctors:

Nursing:

Oral/Dental:

Other Medical Field:

Medical Support:

 

Please indicate the duration of assignments you would consider. Check as many as are applicable.

One week or less

1-2 weeks

2-4 weeks

1-3 months

3-6 months

6-12 months

1-2 years

2 years or longer

 

Have you had previous international medical experience ?

Yes No

If you have, please very briefly describe (limit 250 characters)

 

Please indicate which languages you speak - well enough to perform your medical or medical support assignment.  Choose as many as are applicable. (Hold down the control key to make multiple selections)

 

Please indicate in which parts of the world you would consider an assignment: (Again, choose as many as are applicable using the control key)

 

Would you be willing to work for a religious missionary organization?

Yes No

 

Would you consider assignments that require you to pay for

travel to the destination country?

Yes No

 

Would you consider assignments that require you to pay for food and housing while on assignment?

Yes No

 

If you would like to add anything else about yourself, please enter it here (250 character limit)

 

Please type in a preferred username and password below. Save them so that you can update or delete your record from the registry at a later date. If you are already registered, just type in your existing username and password, and your profile will be updated with the new settings.

Username:

Password:

Confirm Password:

Please review all of the information you have entered. When you are certain that there are no errors, press the submit button below. If you leave some of the data fields blank, you may receive an error message. If so, you can simply go back, fill in the missing data, and resubmit.

Thank You!