Would you like to become a member of DAISI®? 

DAISI® membership is open to doctors or medical students who have volunteered their services with DAISI in the South-Pacific Islands. Associate-membership is open to non-medical volunteers.  

If you would like to become a member or associate-member, please complete the contact form below and indicate when and where and how long you have volunteered in the South-Pacific Islands.

Your Name (required)

Your Email (required)

Your Mobile

Your Postal Address

Select Country

Would you like to receive a DAISI® Polo Shirt (see image below)?

Polo Shirt Type

Polo Shirt Size

Select the number of polo shirts

Select Shirt colour

Would you like to receive a DAISI® Cap? (see image below)

Select the number of Caps

Select Cap colour

Terms & Conditions for Membership & DAISI® Constitution

Have you read and agree to abide by the above Terms & Conditions for membership and the DAISI® constitution?
 Yes No

Please describe your volunteer work in the South-Pacific Islands with DAISI to date.

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polo-shirt