Anam Nagar Polyclinic and Community Hospital::Designed and maintained by IdeaLab | www.idealab.com.np

Anamnagar Polyclinic & Community Hospital

House No. 745, Anamnagar-32

Kathmandu, Nepal

Phone : 977-1-4246351, 977-1-4232340

Fax : 977-1-4219221

Email : contact@polyclinic.com.np

Here is the Volunteer application form. Please fill up the form and submit it to us. We will verify the form and contact you as soon as posible. Volunteer Application Form
Note : Fields with * are compulsory
General Information
*Name
*Gender	Male Female
*Age
*Address	Max. 100 chars.
*City
*Country of Residence
*Passport Number
*State / Province	[only for U.S.]
Field of interest
Experience	Max. 250 chars.

Contact Information
*E-mail Address
*Confirm E-mail Address