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2001 Earthquake 
 
The trust organizes a major medical camp every year in January in the village Bidada, Kutch, Gujarat, India.  Be a part of this incredible healing effort in a number of ways.  We are encouraging non-medical volunteers (young and old) as well as medical students, residents and physicians to participate in the camp.  Lending a helping hand to the needy people brings fulfillment and inner satisfaction unlike any other.

The trust will provide round trip transportation from Mumbai to Bidada, accommodation and meals at Bidada.

For further information on volunteering at the January Camp please fill out the following form and mail, fax or e-mail it to us.

Medical Camp Registration Form

Physicians & volunteers who would like to attend the camp please provide the following information:
Name____________________________________________Age________
Street Address _______________________________________________
City ___________________ State ____________________ Zip ________
Home Phone Number __________________________________________
Cell Number __________________________________________________
Office Number ________________________________________________
Email Address ________________________________________________
Contact Information in India - Name _______________________________
Address______________________________________________________
Phone Number ________________________________________________
CHOOSE ONE: PHYSICIAN   RESIDENT YEAR ____________
VOLUNTEER MEDICAL STUDENT YEAR ____
If Physician/Resident/Medical Student/Nurses specify following:
Medical Degree________________________________________________
Country/State & Year Degree Issued ______________________________
Medical Specialty _____________________________________________
Professional Affiliation __________________________________________
If Volunteer specify following:
Education ____________________________________________________
Area of Interest to Volunteer ______________________________
Email Address ________________________________________________
 

Fill out the following information for EVERY person attending the camp so we can book your train tickets: 

                Name

Age

Departure Date from Mumbai

Return Date to Mumbai from Kutch

If departure or return city is not Mumbai please specify the city.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional Comments or information:
 
 
MAIL OR FAX FORM TO
(If Physician or Resident please also send your CVC & State Registration)
Dr. Manibhai Mehta
11403 Tortuga Street, Cypress CA 90630
Tel 714-898-3156  Fax 714-893-0055
Email: manilalmehta@msn.com
 
Camp Site: Bidada Hospital, Village Bidada, Kutch,Gujarat India
Contact Vijay Chheda Trustee: Tel:(714) 573-1324
E-mail:vijaychheda@hotmail.com