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
Country / Project title / Project dates
1
Your motivation to volunteer in the chosen project

Alternative choice (if any)
Country / Project title / Project dates
2
Your motivation to volunteer in the chosen project
Remarks
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
353-1350 Burrard St.
Vancouver, BC,
V6Z 0C2, Canada
B.   Credit card:  
Name of cardholder
Billing address
Credit Card Number
Expiration date (mm/yy)
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)