Volunteer Enrollment Form

First name

Last name

Birthdate (mm-dd-yyyy)

Age

Gender

Nationality (by passport)

Country of residence

Street address

City

Province / State

Postal Code / ZIP Code

Phone(s) (incl. country and area code)

E-mail

Current occupation

Employer / Educational institution / Other

Languages spoken

Health problems No Yes, specify

Emergency contact name

Relation to you

Phone and/or fax and/or e-mail

Volunteer experience No Yes, specify

Project choice according to your preference
Country / Project title / Project dates

please, note that more project choices will increase your chances to be placed

I want to be placed together with my friend

Remarks

Your motivation to volunteer in the chosen project(s)

Payment information

Financial contribution

Please, choose your method of payment and fill out either part A. or part B.

A. I will mail a cheque payable to:
CADIP - Canadian Alliance for Development
Initiatives and Projects
1350 Burrard St.
Vancouver, BC,
V6Z 0C2, Canada

B. Credit card:

Name of cardholder

Billing address

Credit Card Number

Expiration date (mm/yy)

CVV (Card Security Code)

I acknowledge and accept CADIP Terms and conditions for participation in a volunteer project
(please, note that without this confirmation your request can not be proceeded)