Team Application-Previous Team Member

Team Application

Previous Team Member
Today's Date:

MonthDayYearHourMinutesAM/PM Option
Please click here to read our Refund and Cancellation Policy (PDF).
I have read and understand the Refund and Cancellation Policy.
Full Name (as on passport)

PrefixFirst NameMiddle NameLast NameSuffix
E-mail
Phone (Cell)

Area CodePhone Number
Preferred Method of Contact
Please register me for this trip. (Select all that apply)
Please register me for this trip.
I would like to receive a new scrub top for this trip. I understand that the cost for the new scrub will be added to my trip cost.
If your contact information has changed since your last trip with us, please provide your new information below.
New Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Email
example@example.com
During our mission trips, His Healing Hands staff and/or team members may photograph, film, videotape, record or otherwise reproduce the image and/or voice of any person who joins a His Healing Hands mission trip. By submitting this application to join a His Healing Hands team you are granting permission to His Healing Hands to use any image, video, or voice recording of you for the purpose of promoting His Healing Hands without compensation.
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