MJAA: Survey - Services Donation Form

Services Donation Form

The MJAA is taking names for future plans to staff mobile medical/dental units and to provide vocational and counseling services to the needy in Israel. Presently we hope to offer housing and meals while in Israel, however individuals must provide their own transportation to and from Israel.
We are in critical need of all areas of the Medical Profession. Teachers, especially in teaching Hebrew. Vocational instructors, and counselors specializing in all areas of trauma and mental health.

	Thank you for your interest in donating services badly needed by the poor in Israel.
	Question - Not Required - Organization
*	Question - Required - Contact Name
*	Question - Required - Phone Number
	Question - Not Required - Email
	Question - Not Required - Fax
	Question - Not Required - Mailing Address (Maximum response 255 chars, approx. 5 rows of text)
	Question - Not Required - Professional Services (Maximum response 255 chars, approx. 5 rows of text)
	Question - Not Required - Availability (Maximum response 255 chars, approx. 5 rows of text)
	Question - Not Required - Additional Questions (Maximum response 255 chars, approx. 5 rows of text)