This is the application for consideration for the Benign Program administered by Operation Heal the Nations. Please fill out to the best of your ability. Once we review, we will contact you.
Submitting this application is not a contract, it does not guarantee acceptance into our Program or Association, and does not constitute any payment agreement. The purpose of this application is to gather information to determine if you would be a good candidate for the program.
We understand that there may be still more questions or concerns that you have while filling out this application about the material addressed. If you do think of questions while filling out this application, you can put these at the bottom of this form in the "Questions/Concerns" field and we will be sure to address those and any other questions you have one-on-one.
Please select "Next" to continue.