Volunteer Application

Please submit the form below or click here to download a printable form to submit by email to Info@resolute.health.

 

Personal Information
Name *
Name
Address
Address
Phone *
Phone
Volunteer Questions
Travel Questions
Select travel availability
We are planning our next medical mission. Please indicate your availability by choosing a week or weeks that work best with your schedule. (select multiple weeks if you plan to stay for two weeks, or overlap).
Departure airport city:
Departure Date *
Departure Date
Return Date *
Return Date
RHO can only book travel through Ethiopian Airlines. Would you like RHO to book your travel for you? *
During previous trips to Ethiopia, participants have stayed at the Embilta hotel. It is safe, free, and within walking distance to SPHMMC (driver also available). Participants working at Black Lion require a driver. However, we care about your safety and comfort. Where would you like to stay in Addis?
This form is secure and confidential and will only be used for purchasing tickets and in the event of an emergency.
Date Issued
Date Issued
Expiry Date
Expiry Date
Date of Birth
Date of Birth
Emergency Contact Information
Contact's Name *
Contact's Name
Contact's Phone Number *
Contact's Phone Number
(+1 is the country code for USA and Canada)