Remote Area Medical
Volunteer for Wise RAM July 18, 19, & 20, 2014
Medical Professional Volunteer Form
Temp. VA Med. License Application Form
Temp. VA Med. License Sponsor Form
RAM Clinic NP Practice Agreement
General Volunteer Form
Education & Exhibit Application Form
NOTICE: Due to the high number of volunteers that participate in Wise RAM, walk-up on-site registration on the day of the event will be prohibited.
Medical Professional Volunteers
To volunteer as a medical professional please complete our Medical Professional Volunteer Form to volunteer for Wise RAM 2014. Medical Professionals will also need to send a copy of their medical license to The Health Wagon. Nurse Practitioners are required to sign and submit the RAM (Remote Area Medical) Clinic NP Practice Agreement. Once the information has been received you will be notified by June 30 of your acceptance. Volunteer applications must be submitted by June 1 for medical professionals and June 15 for optometrists. To submit a copy of the RAM Clinic NP Practice Agreement, Medical Professional Volunteer Form or a copy of your license via fax: (276) 328-8853, email: firstname.lastname@example.org, or mail: P.O. Box 7070 Wise, VA 24293. Additional information or questions call (276) 328-8850.
*If you prefer to fill out the form by hand you can download the Volunteer Form as pdf complete and send via fax, email, or mail.
*Professional registration will also be open after June 1 to fill specialty areas as they become available.
Temporary VA Medical License Information
Medical and dental providers that are out of state and do not have a Virginia medical license will need to obtain a temporary license prior to Wise RAM. Click here to download the application to submit for a temporary Virginia license. Click here to download the sponsor certification form (also required).
General volunteers (non-medical professionals) please submit the General Volunteer Form to volunteer for Wise RAM 2014. Once you have submitted the General Volunteer Form you will be notified by July 10 of acceptance. Applications for general volunteers must be submitted by June 15.
*If you would prefer to fill out the form by hand you can download the Volunteer Form as pdf and send via fax: (276) 328-8853, email: email@example.com, or mail: P.O. Box 7070 Wise, VA 24293.
Dentists, dental hygienists, dental students, dental specialist, and other dental volunteers please visit http://www.vdaf.org/Wise-MOM-Project/ for additional information and submit a volunteer application.
If you would like to set up an education exhibit or a booth please download the Education & Exhibit Application Form. Due to limited space availability requests will be reviewed by the organizing committee prior to the event for approval. Please send the completed form to: The Health Wagon, P.O. Box 7070 Wise VA, 24293 or Fax: 276-328-8853.
Housing for RAM is available at local hotels. Click here to download a list of local hotels with their addresses and contact information.