Health Care Providers: Help Tropical Clinics Make a Difference in Rural Community Health Care

We seek to develop an outreach program for medical care professionals, nutritionists and health educators from around the world to share expertise with local health professionals and gain knowledge in tropical medicine.

Please complete the following form for more information on how you can help us make Tropical Clinics a reality:

Name *
Email address *
Address
City
U.S. State/ Canadian Province
Country
Zip/Postal Code
Contact Phone	(Please include area code, as well as country code if outside North America)
Type of heathcare practice	(Alternative practitioners are also encouraged to apply)
Are you cleared to provide healthcare in Africa?
Yes No
What length of time would you be able to devote to TropicalClinics, Kakamega?

Will you be traveling with a team of health care providers?
Yes No Not sure
Will you be able to bring any sort of diagnostic kit? (including, but not limited to Malaria, Tuberculosis, HIV, Influenza)
Yes No
If yes, what kind?

Would you be able to attend a medical camp in Kakamega (July 1- July 10, 2008)?
Yes No
Questions or Comments?