One moment please...
Occupation and Position Title
If you are a Veterinarian, please indicate the states in which you are currently licensed to practice.
Address Line 1
Address Line 2
Have you volunteered on campaign with AB in the past either domestic or international?
Yes - domestic
Yes - international
Yes - both domestic and international
Which Animal Balance Program are you interested in participating in?
VET AID // GALáPAGOS ISLANDS
AB USA // APACHE NATION, AZ
AB USA // LOUISIANA
AB USA // NAVAJO NATION, NM
AB USA // TEXAS
AB USA // WASHINGTON
Preferred Campaign Availability
In addition to your chosen campaign site, please let us know what your dates of availability are.
Are you fully vaccinated against COVID-19?
Partially - please explain in notes
I'm not fully vaccinated but...
Are you over 18?
Are you over 21 years old?
Date Of Birth
Health and Physical Fitness
Do you suffer from any illness, including but not limited to asthma, epilepsy, diabetes, allergies? Do you take any prescription drugs or over-the-counter medicines? Have you had any psychological / psychiatric illness in the last three years? If yes to any of the above, please supply more info in the box. If no, Enter N/A. *
Do you have health insurance?
Do you have any dietary restrictions?
If you chose YES please explain here.
Please Tell Us About You
Please list some of your interests, previous travel / volunteering experience, language skills, first aid, and any other relevant information or qualifications which might be useful.
Please provide names and contact information for your references (3):
How did you hear about us?
Please check this box if you want to join Animal Balance's general mailing list
Join Animal Balance's General Email List