IAMM Pharmacy VOLUNTEER REQUEST FORM: San Pedro de Macorís in the Dominican Republic July 25th

IAMM VOLUNTEER REQUEST FORM: San Pedro de Macorís in the Dominican Republic July 25th - August 1st of 2026

This form is open for those interested in being part of the international mission in Dominican Republic
All fields marked with * are required and must be filled.
Name*

First NameLast Name
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Number *
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
Alternate Phone #
Please enter a valid phone number.Format: (000) 000-0000.
July 25th - August 1st of 2026
YesNo
MenWomenSmallMediumLarge1X2X3X4X
- YesNo
- YesNo
- Name exactly as it appears on your passport*
- Input Passport Number exactly as it appears on your passport *
- Passport Expiration Date*
  
  MonthDayYear
  Date
- Upload Passport*
  
  Cancelof
- Name
  
  First NameLast Name
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- SpouseParent (or Grandparent)Child (or Grandchild)Other
- Emergency Contact Telephone #:
  Please enter a valid phone number.Format: (000) 000-0000.
- PharmacistPharmacy AssistantOTHER
- Submit two Headshots: 1st*
- 2nd Headshot*
- MEDICAL Area of Specialization
- Number of years in MEDICAL practice:
- Upload Diplomas
  
  Cancelof
- UPLOAD MEDICAL CREDENTIALS: *
  
  Cancelof
- Upload letter of Good Standing medical License.
  
  Cancelof
- College (medical) transcripts.*
  
  Cancelof
- Upload background check.
  
  Cancelof
- Form / Amount Payment (ALL PAYMENTS should be sent directly to Sandra Franklin. This form does not accept payments.)
  
  Payments may be made by Check / Money Order, Credit Card, Zelle (IAMMonline@gmail.com), or CashApp ($IAMMdonation). Make all Checks or Money Orders payable to ($250 nonrefundable deposit):
  
  International American Medical Mission
  
  11355 S. Halsted Street
  
  Chicago, Illinois 60624
  
  ATTENTION: Sandra Franklin
  
  (773) 568‑2929
  
  ALL PAYMENTS should be sent directly to Sandra Franklin. This form does accept payments.
- I acknowledge that by submitting this Volunteer Request Form, I am expressing my interest in volunteering with the International American Medical Mission. Furthermore, I understand that if my application is accepted and I become a member of the IAMM Team, I am required to submit a non-refundable deposit for the medical mission, payable to IAMM.
- Signature
  
  Clear
- Should be Empty:

IAMM VOLUNTEER REQUEST FORM: San Pedro de Macorís in the Dominican Republic July 25th - August 1st of 2026