HOPE HEALTH CAMP 2024
HOPE HEALTH CAMP 2024
Registration Form
Name
*
Name
First
First
Last
Last
Age
Sex
Male
Female
Phone Number
Place of Residence
Bunamwaya
Kajjansi
Katale
Kikumbi
Kirimanyaga
Kisigula
Kisingiri
Lubowa
Lufuka
Lunya
Nalumunye
Nankinga
Naziba
Nfufu
Ngobe
Nyanama
Seguku
Zzana
Other
OtherResidence (If not in List)
Medical Issue (Check where applicable)
Diabetes
Highblood Pressure
Optical (Eyes)
Cardiac (Heart Issues)
Malaria
Cough and Flue
HIV/AIDS
Dental
Other
Other Medical Issue (If not in List)
Register
If you are human, leave this field blank.
