 |
Eastern Shore Children’s Regional Oral Health Consortium Taking A Bite Out of Early Childhood Tooth Decay Eastern Shore AHEC P.O. Box 795 Cambridge, MD 21613 410.221.2600 ext. 106 phone/ 410.221.2605 fax croc@esahec.org |
C.R.O.C. Volunteer Corps Registration |
Volunteer Full Name Printed with Degree Designation: |
Mailing Address: |
Email Address: |
Home/Work/Cell Phone Numbers: |
Ideal Days/Hours of C.R.O.C Corps Service: |
Areas of Service Desired (check any/all): ______School Dental Caries Screenings/Fluoride Varnish Applications |
Please return completed form with copy of your current license & CPR card to either; address, fax or email listed above. You will be called and offered an opportunity to serve when the area/areas of service become available. Thank you in advance for your valuable assistance to the underserved children of the Eastern Shore. Alexandra Hall RDH |