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Volunteer Trip Request Form

Join our volunteers in spreading the gift of healing around the world.

ReSurge volunteers pay a flat fee of $325 toward travel expenses; ReSurge covers all remaining transportation and accommodation costs, although team members are responsible for some of their own meals during the trip.

Team members should not plan any international travel one month prior to the departure date, due to difficult visa authorization processes. ReSurge will hold team members' passports until the visas are obtained. Please note all passports must be valid for a minimum of six months past a trip's return, and contain at least two blank visa pages.

Due to excess baggage issues, a maximum of five team members will be given permission to extend their stay and ReSurge will ask each individual staying to pay $100. No deviations from the team itinerary can be allowed for Mali and India.

If you are interested in volunteering with us, please complete the volunteer trip request form below.

Fields in RED are required.
  Name: (required)
Specialty:
Please check the box next to the trip(s) you are interested in volunteering for (you can check more than one):
Surgical Team Trips
Cao Lanh, Dong Thap, Vietnam: Fri. 11/9 - Sat. 11/24/12
Piura, Peru: Sat. 12/1 - Sat. 12/15/12
San Juan Sacatepequez, Guatemala: Sat. 12/8 - Sat. 12/15/12
Dehradun, Uttarakhand, India: Fri. 1/11 - Sat 1/26/13
Phan Rang, Ninh Thuan, Vietnam: Fri. 2/22 - Sat. 3/9/13
Quy Nhon, Binh Dinh, Vietnam: Fri. 4/5 - Sat. 4/20/13
La Paz, Bolivia-Hand: Sat. 5/4 - Sat. 5/18/13
I need at least notice to go on an ReSurge trip.
 
Home Phone:
Work Phone:
Cell Phone:
Pager:
E-Mail Address:
Mailing Address:
City:
State/Province:
Postal Code:
Country:
ReSurge volunteer nurses are required to answer the following questions if they want to be considered for a trip this fiscal year:
1. Currently employed in:
 
2. Years of experience in above specialty:
3. Number of ReSurge trips you've been on:
4. Date of last ReSurge trip:
5. # of days worked per week in specialty
6. Percentage of pediatric patients in current practice:
7. Percentage of adult patients in current practice:
8. Name of current supervisor:
9. Phone number of current supervisor:
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