Interplast Application

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EXPRESSION OF INTEREST
IN BEING A ROTARY OBSERVER
ON AN INTERPLAST PROGRAM

The program is scheduled for Honiara, Solomon Islands from 28th June to 12th July. However, please note that Rotarian Observers will depart on 28th June along with the rest of the team and will return home probably on Thursday 5th July.

Departure is on a Thursday because of flight schedules. The Triage Clinic will probably be held on the Friday (29th June) and operations commencing on the Monday (2nd July). This means that the lucky Observers will probably have a free weekend in Honiara.

We have Rotarian contacts in Honiara and I'm going to see if it's feasible and appropriate to arrange home hosting for the two Rotarian Observers - District 9790 and District 9810 = for the Friday and Saturday nights, returning to the hotel on Sunday evening. I think this would be a wonderful opportunity for them, apart from the obvious fact of saving some money for Interplast. The surgical team will probably take some time away from the city because they will be patient-free.

Applicants will ned to familiarise themselves with the Guidelines:

Click here for the Interplast Guidelines

Glenda Sherwin-Lane
t +61 (3) 9249 1231
m 0414 769 459
email: Glenda Sherwin Lane

Name of submitter:

Your email address:

Address:

Suburb

Postcode:

Home telephone:

Mobile:

Select your club - Rotary Club of:

Year Joined:

Highest Club office held:

Highest District Office held:

Name of the Secretary of your Rotary Club:

Contact details of club secretary:

SECTION TWO

1. Please summarise your personal/business background:

2. Please summarise your Rotary Background/involvement/interests:

3. Please describe why you want to be a part of an Interplast program:

4. Please describe why you think you are a suitable candidate to accompany an Interplast team (incl special skills, qualifications, training that you believe will be an advantage)

Would you be prepared to serve on a Rotary District Interplast Committee?:

Yes

No

What will you do to promote Interplast (and Rotary International) upon your return:

Do you undertake to speak at Rotary Clubs, Assemblies and Conferences

Yes

No

If selected to represent my Club/District I understand I am a member of an Interplast Team and Interplast are funding my trip and as such I agree to focus my attention during the stay on the activities of the Interplast Team and the Program. Whilst in the recipient Country I will make no promises of support on behalf of Interplast and should I identify another need (outside the scope of Interplast) I will take this back to my Club/District without any recourse to Interplast for support.

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Last modified: 9 Apr 2012 22:52