PRINCESS EJEMEN FOUNDATION
MEDICAL MISSION SIGN UP FORM
Name:
Address:
Phone:
Email:
Are you willing to travel to Nigeria for a minimum of one week at a time?
What are your preferred months of travel?
What is your profession?
If medical, what is your specialty?
Are you willing to go on a medical mission to Nigeria in June 2010? If yes what is your preferred date of departure?