VOLUNTEER SIGN-UP FORM (2011)
Open to Medical students, Physicians, PharmDs
Welcome Video to The BRIDGE Healthcare Clinic


DIRECTIONS
1. Register on our registration site. You will then be redirected to this site to sign-up for one of the available clinic dates.
2. Once you have registered your information, peruse the volunteer openings for the clinic dates below.
3. Select a clinic date on which you would like to volunteer.
4. Enter the email address you used to register with us and click Submit.
5. After you click Submit, this page will automatically refresh and your name will appear next to the clinic date you chose when you have successfully signed up.

IF YOU ARE A RESIDENT, and not licensed and board certified in FL, please ensure you sign up only for dates on which there is already an attending from your specialty (IM or FM).

If you run into any problems, please notify Web Master. You may also contact Jane if you need to change your class year in our registration database.

If you cannot make it on a date you've previously signed up for, please find your own replacement and let Malverka Sharma or Niraj Jani know.

MSI and MSII students, please be considerate of your classmates and limit your sign-up to one night every two months.

SIGN UP

CLINIC DATE:

EMAIL:
This is a case sensitive application. Please enter your email address EXACTLY as you entered it when you registered.

MS I/II - Three
(Two on GYN Nights)		MS III/IV - ThreePhysicians - TwoPharmDs - Two
(Zero on GYN Nights)
6/29/10
7/6/10
7/13/10
7/20/10
7/27/10
GYN Night
8/3/10
8/10/10
8/17/10
8/24/10
8/31/10
9/7/10
9/14/10
9/21/10
9/28/10
GYN Night
10/05/10
10/12/10
10/19/10
10/26/10
11/02/10
11/09/10
11/16/10
11/23/10
11/30/10
GYN Night
12/7/10
12/14/10
1/4/11
1/11/11
1/18/11
1/25/11
GYN Night
2/1/11
2/8/11
2/15/11
2/22/11
3/1/11
3/8/11
3/15/11
3/22/11
3/29/11
GYN Night
4/5/11
4/12/11
4/19/11
4/26/11
5/3/11
5/10/11
5/17/11
5/24/11
5/31/11
GYN Night


S = Speaks Spanish
O = Speaks other language(s)
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