Stryker Kits Application Name* First Last Email* Phone*Requesting Organization* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire - Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandColombiaComorosCook IslandsCosta RicaCôte d’IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHoly SeeHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRepublic of the CongoRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands - BritishVirgin Islands - U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Briefly describe your organization, work, or program and how it will involve the use of Stryker instruments.* Location where supplies will be used:* Anticipated Departure Date MM slash DD slash YYYY Please select your Stryker kit:*Large Bone Battery-Powered Drill/Saw SetSmall Bone Battery-Powered Drill/Saw SetNeuro KitENT KitSpine Kit I am interested in learning more about or participating in Project C.U.R.E. Clinic Trips How did you hear about Project C.U.R.E.'s Stryker Kit donation program?CommuniqueFriendNews MediaHospital/HospiceEmployerCommunity GroupReligious InstitutionEducation InstitutionSocial MediaInternetEmailUSA GovernmentOtherNotes/Special Instructions*Terms & Conditions* Do you agree that all of the supplies will be used outside the U.S. and will not be sold or bartered for property or services? * Are you aware of country procedures to clear medical supplies through customs to avoid confiscation and/or paying duties/taxes? * Do you agree to sign our release of liability to receive medical supplies? * Do you agree to notify Project C.U.R.E. if these supplies are lost or stolen prior to their arrival at their final destination? * Do you agree to take part in Project C.U.R.E.'s post trip assessment? CAPTCHA
