I would like to register and apply for participating as a Clinical/Non-Clinical volunteer in the Nepal Dental Outreach Project 2017 under the international Nepal Oral Health Care Programme 2015-20.


I would like to register and apply for participating as a Clinical/Non-Clinical volunteer in the Nepal Dental Outreach Project 2017 under the international Nepal Oral Health Care Programme 2015-20.


* Required Fields

Section A: Personal Details


Date of Birth*


Contact Information



Postal Address


1st Emergency Contact Details *


2nd Emergency Contact Details




I hereby furnish the particulars about myself as in the following :

I am a current (Please tick the appropriate column):

Sn Occupation Please Tick One
1 Dentist
2 Dental Nurse
3 Dental Hygienist
4 Dental Therapist
5 Dental Assistant
6 Dental Student
Sn Occupation Please Tick One
7 Student of
i) Dental Nursing
ii) Oral Health/Dental Hygiene
iii) Dental Assistant/Dental Therapy
iv) Others(please specify)
8 Public Health Worker/Administrator
9 Others (please specify)

Are you an alumni of the AGP Dental Outreach Volunteering Program? If yes, please specify.

Are you sigining up in group? If yes, please specify the name of the University or the Group.

Are you currently employed? If yes, please specify the position held and the name of the organization.


I would like to select the following date :

Please select the first and second preferred dates

First preferred dates
Second preferred dates (if opted)


Nepal Dental Outreach Volunteering
Impact 2014 - 2017

Free screening, prevention, diagnosis & treatment of dental diseases.

10096

Hours of volunteering by 382 professionals & students

22352

Procedures on 21061 patients

11415

Students from 68 Schools