MyImpactPage - DocTours Medical Volunteers

Already have an account on MyImpactPage.com? Login to auto-populate your details!

Don't have an account on MyImpactPage.com? Just fill in your details to get started!

Account

UsernameRequired
Password

Required

	Has at Least 8 Characters
	Has at Least One Upper Case Character
	Has at Least One Lower Case Character
	Has at Least One Number

Confirm Password

Required

	Has at Least 8 Characters
	Has at Least One Upper Case Character
	Has at Least One Lower Case Character
	Has at Least One Number

Name Fields

First NameRequired
Last NameRequired

Address

Address line 1Required
Address line 2
CityRequired
CountryRequired
State / ProvinceRequired
Zip / Postal CodeRequired
Email Address Required

Phone Numbers

Required Please enter at least one phone number

Home Phone
Work Phone

Cell Phone
Phone Preference

Misc Fields

Region
reCAPTCHA

Your Elective or Medical Volunteer Program

Country where you wish to visit? (First preference)

Country where you wish to visit? (Second preference)

Preferred department for your elective or volunteer program?

Your current profession? (ie Student, Doctor, Nurse, or ...?)

Requested role? ( eg Medical elective, Student Placement, Research, Practice, Teaching?)

Start Date

Duration of your elective or volunteer program (in weeks)?

Do you wish to be located with a friend(s)? Please advise their name(s).

Any other comments or preferences for your program(s)?

Personal Data

Details of any dietary requirements:

Details of any allergies or health concerns that may prevent you from performing certain kinds of work or in a certain work environment?

Level of travel experience to developing countries?

Any languages spoken (other than English)? Please provide details.

Preferred t-shirt size?

Where did you hear about DocTours?

Emergency Contact

Emergency contact name

Phone number and email address

Relationship to you?

Documents to upload - these documents can be uploaded later or forwarded to us separately.

Resume / brief CV

Passport (copy of the photo page)

Letter of Good Standing

Digital photo (selfie)

Working with Children / Police Background Report

Any other documents that may be required

References

Name

Email and Phone Number

DocTours Terms and Conditions

DocTours Terms and Conditions - please read and agree to the T&C's Required