Volunteer Registration

Contact Information

Salutation

First Name*

Last Name*

Gender*

Male Female Other

Email*

Postal Address*

Suburb*

State*

Postcode*

Country*

Date of Birth*

Mobile Phone Number*

Alternate Phone Number*

T-shirt Size*

Tell Us About Yourself*

Passport Number*

Passport Nationality*

Passport Expiry Date*

Airline Seating Preference

Airline Dietary Preference

Frequent Flyer Number(s)

Carrier	Number

Please advise of any relevant medical history and current treatments

Emergency Contact Details

Next of Kin / Emergency Contact Name*

Next of Kin / Emergency Contact Email*

Next of Kin / Emergency Contact Phone*

Team Role

Professional Qualifications

Current Hospital*

Clinical Qualifications*

Referees*

Clinical Experiences*

AHPRA Registration No.*

Not Applicable

Registration Expiry*

Documents

Maximum file size 7MB

Curriculum Vitae* (.PDF, .Doc, .Docx)

Medical Qualifications* (.PDF, .Doc, .Docx, .JPG, .JPEG)

Second Medical Qualifications (.PDF, .Doc, .Docx, .JPG, .JPEG)

AHPRA Registration* (.PDF, .Doc, .Docx, .JPG, .JPEG)

Scanned copy of your Passport* (.PDF, .Doc, .Docx, .JPG, .JPEG)

Professional Photo (Passport Style)* (.JPG, .JPEG)

Casual Photo (For your profile on our website)* (.JPG, .JPEG)

Terms and Conditions

I agree to the Volunteer Agreement.

I agree to the Code of Conduct.

I agree to the Child Protection Policy.

Signature

Please draw your signature below

Volunteer Registration Submission

Please wait

THANK YOU FOR REGISTERING

Open Heart International does not exist without volunteers, people like you that are willing to be a part of assisting the communities that we are working in. We are grateful for your interest in helping us help others.

We have now received all the information you have submitted, and we will begin a short checking and verification process. Should you be accepted, you will then receive a volunteer’s login and password to this website an further instructions. You will also be subscribed to our volunteer database and email database.

To get better acquainted with Open Heart International, we recommend you download our Volunteer Guide if you have not already. Click here to download the guide.

If you have any additional questions, please feel free to contact us.