Volunteer Application
Join Our Next Mission in Jamaica: May 7th - 12th
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Gender
*
Occupation or Education Status
*
Are you a licensed dentist?
*
Yes
No
If yes, what is your license number?
*
Do you have a current passport?
*
Yes
No
Name on Passport
*
First Name
Last Name
Passport Number
*
Passport Issue Date
*
-
Month
-
Day
Year
Date
Passport Expiration Date
*
-
Month
-
Day
Year
Date
What country was your passport issued in?
*
Will your passport be valid for at least 6 months after the trip end date (5/12/23)?
*
Yes
No
Why are you interested in joining this mission?
*
Team Roster Photo
*
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TERMS & CONDITIONS
REFUNDS I acknowledge that the funds for this trip are nonrefundable and that if I am unable to attend this trip for any reason or need to come home early for any reason that these funds will be considered a donation and tax deductible to the fullest extent allowed by law. All expenses incurred during international air travel will be my responsibility, including but not limited to any flight delays or cancellations. Should I miss any connecting flight all expenses incurred to get me to the group will be at my personal expense. Should the dates of my participation in the project change or be shortened no refunds will be available and any costs or fees related to changing my itinerary will be at my own expense.
*
Yes
UNDERSTANDING MY DONATION I know and understand that my donations to A Broad Smile Foundation are to be used for the greatest needs in the region that I am applying.
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Yes
I KNOW AND UNDERSTAND THAT I AM MAKING A DONATION TO A 501C3 NONPROFIT ORGANIZATION WHICH IS NONREFUNDABLE, NONTRANSFERABLE AND SHOULD I NOT TRAVEL WITH THE ORGANIZATION, THESE FUNDS WILL BE USED FOR THE GREATEST NEEDS OF THE ORGANIZATION.
*
Yes
SUBMIT
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