Central American Medical Outreach

Bo. El Calvario 322 Westwood Ave.

Santa Rosa de Copan Orrville, Ohio 44667

Honduras, C.A. (330) 683-5956/(330) 682-9978

(504) 662-2118 camo@camo.org/ www.camo.org

APPLICATION FOR TEAM PARTICIPATION

CONTACT INFORMATION

NAME _________________________________________________________________

ADDRESS ________________________________________________________________________________________________________________________________________________

PHONE_______________________ CELL ____________________________________

EMAIL ________________________________________________________________________

PERSON TO CONTACT IN CASE OF EMERGENCY

NAME ______________________________________________________________________

ADDRESS ________________________________________________________________________________________________________________________________________________

PHONE_______________________ CELL ____________________________________

EMAIL ________________________________________________________________________

DESCRIBE PREVIOUS INTERNATIONAL THRID WORLD EXPERIENCES:

________________________________________________________________________

DO YOU SPEAK SPANISH? _____________________________________________________________

FLUENT ________________ (Understand 95-100% and are able to read and write)

MODERATE _____________(Can understand but at times it is difficult to catch the complete meaning, need people to repeat)

MINIMAL: ______________(Can get around, difficult to have a conversation)

DESCRIBE PREVIOUS INTERNATIONAL HEALTH EXPERIENCES:

DO YOU KNOW ANYONE ELSE WHO HAS BEEN A CAMO TEAM MEMBER?

WHAT DO YOU EXPECT TO GAIN FROM PARTICIPATING ON A CAMO TEAM?

WHAT SKILLS CAN YOU CONTRIBUTE TO A CAMO TEAM/MISSION?

SIGNATURE:____________________________ DATE:________________________

Thanks you for your application and your interest in international health. Please send to our office. Your application will be reviewed- the Board of Directors of CAMO makes the final decision on team members. All members of the team are responsible for covering the cost of travel and accommodations while participating on the team mission.. Air travel is arranged through CAMO and must be paid in advance. If you cancel or change dates the penalties are your responsibility.