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Online Application

VIM Clinic Volunteer Application Form

If you are interested in volunteering with the Volunteers in Medicine Clinic, please fill out this form and we will get in touch with you as soon as we can.
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CH 13031 A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE
1-800-435-7352 WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.