Mission Trip Interest Form

Thank you for your interest in joining us on one of our medical mission trips.

More information, along with the applications and required forms, will be sent out a few months before the trip.

The cost of each trip is $2,500.00.

If you plan to begin fundraising early, please make sure that your name and the trip date are included with each donation so that we can properly credit the funds toward your trip.

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

City & State of Residence

I am interested in participating in the following mission trips in 2027:

Other

Please Explain

I am interested in serving as:

Type of Specialty

Which clinical areas do you have experience in? (check all that apply)

How did you hear about these mission trip(s)?

Please provide their name

Please provide name of the church