Notes: 1. Your acceptance will be based on the information provided on this form. 2.You will be responsible for arranging your own funding for the costs of the trip to include travel expenses, lodging (prior to and after the mission dates) , Evacuation Insurance ( optional ) . 3. The major costs of the trip will be managed by MMOM USA which will include lodging (during the Mission trip and only if you stay for the full duration of the mission trip) , Food during the Mission only, Transportation/Transfers to and from the mission site and Miscellaneous costs such as purified water, hand gel, paper products, etc. The costs of your voluntary participation may be tax deductible. The Medical Mission of Mercy USA is a non-profit 501 (c) 3 organization in the State of Maryland. You should consult your tax advisor on this matter. 4. Travel arrangements: You are responsible for coordinating your flight itinerary. Each volunteer will be informed in advance of the pre-determined meeting place. Upon arrival at the predetermined location, MMOM, USA will make all necessary arrangements to and from the mission site. If you are not able to meet the group at the pre-determined location and / or cannot stay for the full duration of the mission, you will be responsible for your own arrangement to and from the mission site. We encourage you to discuss all alternative arrangements with MMOM, USA. Deadlines are established and must be adhered to at all times to include but not limited to paperwork and payments. I hereby apply for membership in the Medical Mission of Mercy, USA (PAMMMWDC, Inc). If accepted as a member, I promise to abide by the Constitution and By-laws of the Medical Mission of Mercy, USA. I am enclosing a non-refundable annual contribution fee of twenty five dollars ($25.00) to cover administrative costs.