CANADIAN FRIENDS OF DVI
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Home
About Us
About
FAQ
Media
News Blog
Sponsors
Featured Volunteers
Events
Miles for Smiles Zooz-a-Thon
Sponsors
Past Events
Support Us
Donate
Volunteers
Application Form
Contact
Volunteer Application Form
Please fill out the following form (or print and email it to the address on the
Contact
page).
Your Information
*
Indicates required field
Name
*
First
Last
Email
*
Home Phone Number
*
Mobile Phone Number
*
Office Phone Number
*
Fax Number
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Languages Spoken (mother tongue first)
*
Dental Background
Dental School
*
Year Graduated
*
Choose Degree(s)
*
D.D.S.
D.M.D.
B.D.Sc.
Other
Other Info:
*
Country of License
*
License Number
*
Post-Graduate Training
*
Specialty Program
*
Are you a member of a Dental Association/Academy?
*
Yes
No
Which?
*
Private practice?
*
Yes
No
Number of hours per week?
*
Dental Clinic Address
*
Do you treat children?
*
Yes
No
Approx. percentage of practice treating children
*
Other
How did you find out about DVI?
*
Internet
Professional Association
News Articles or Brochures
Professional Conferences
Other
Other:
*
Did a specific colleague refer you to DVI?
Name of Colleague:
*
Preferred volunteering dates:
(Note: apartments at DVI are available from Friday to Friday)
Friday of Arrival - 1st Choice
*
Friday of Arrival - 2nd Choice
*
Friday of Arrival - 3rd Choice
*
Number of weeks available to volunteer
*
How many family members are joining you?
*
Ages of family members
*
Comment
*
Submit