Volunteer

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