2026 Volunteer Recruitment Form

2026 Loloma Foundation Volunteer Application

Fill in the form below to volunteer to our organization
Name as it appears on Passport

First NameMiddle NameLast Name
Passport #
Birth Date

MonthDayYear
Please upload photo or PDF of your passport

Cancelof
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Occupation
What is your occupation
Employer
Overseas volunteer experience? Where?
If you are a medical/dental professional: Do you have license in good standing?
Area of Specialty
Have you traveled internationally?
Dietary restrictions?
Do you have secondary skills that might be useul on a mission?
Which Loloma mission are you interested in?
Check dates and details at: www.lolomafoundation.com/medical-missions
Will you be extending your travel at beginning or end of mission?
You can always change you mind.
Do you need accommodations for travel extension?
We can arrange
Please enter early departure date from US to Fiji

MonthDayYear
Date
Please enter later return date from Fiji to US

MonthDayYear
Date
Why do you want to join a Loloma team?
Should be Empty: