First Name Last Name
Street
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Phone (Home) Phone (Cell)
Email:
Best way to contact you: Select email phone
Best time to contact you: Select mornings afternoons evenings weekends anytime
I am interested in helping in the following area(s): (Check all that apply)
MEDICAL ( Doctor, Nurse Practitioner, Physician's Assistant, Nurse, )
OPTOMETRY
MARKETING & DEVELOPMENT
GRANT WRITERS
COMPUTER SPECIALISTS
MAKING PROFESSIONAL PRESENTATIONS
ASSIST WITH FUND RAISING PROJECTS
OTHER or Clarification– PLEASE DESCRIBE
Availability
What time period would you be available?
Availability - days of week, time of week, specific blocks of time
Can you travel to Hinche, Haiti? (we do not provide assistance with travel costs)
YES NO
How did you hear about Maison Fortune Orphanage or the Foundation?
MANY HANDS WORKING MAKE THE LOAD LIGHTER FOR ALL