Name * First Name Last Name Phone * (###) ### #### Email * Are you interested in participating in our future mission trips abroad? Yes No Please check all that apply that may interest you: * Marketing Website Social Media Photography Videography Video Editing Event Planning and Fundraisers Shadowing Nurses & Surgeons Translation Raise Awareness SpineHope Ambassador Do you speak any foreign languages? Yes No If so, which ones? How would you rate your fluency? Please rank below (1 = None, 10 = fluent) 1 2 3 4 5 6 7 8 9 10 If you are a student, please fill in the information below: University: Major: Year Freshman Sophomore Junior Senior Other If selected Other, please state what: Are you interested in earning a certificate to fulfill community service or volunteer hours? Yes No Thank you!For more information, please email spineoutreach@gmail.com or visit www.spinehope.org Vision: Every child with a spinal deformity has an opportunity to have a normal life. Mission: SpineHope transforms the lives of children worldwidethrough surgery, education, and research.
