Medical Wings International - Mission Application Form

Medical Wings International Mission Application Form
This form must be completed, submitted and processed for you to be considered for a slot on a mission!

Need more reasons to join our missions? How about 200 million reasons. There are more than 200 million children under the age of five worldwide in need of basic healthcare, 10 million of these children die each year from treatable ailments.

Applications are only accepted from current members of Medical Wings International, in good standing.
If you are not yet a member please see our Membership Application

Tell us how we may contact you:

Are you a member of MWI in good standing?:

(if not, this application will not be processed or considered)

Mission Trips and Dates:

Home airport, city from which you will be flying American Airlines?:

Please list your reasons for wanting to join this mission.

Are you fluent in any languages besides English? If so, what are they?

Have you participated in a medical mission before?

Name:
(exactly as it appears on your passport.) Title, Dr/Mr./Mrs./Ms etc.

Cell Phone:

E-mail:

Profession:

Place of Employment:

Employment Address:

Employment City/State/Zip:

Employment Telephone:

A passport is required for all trips and generally takes time to obtain. If you already have a passport, please check the expiration date. IF it expires within 6 months from departure date of the trip, please have it renewed.
Do you have a current passport, with an expiration date more than six months away?

Passport Number:

Passport Expiration Date:

It is very important for us to know who referred you to Medical Wings International.

Name of person who referred you:

Phone number of person who referred you:

E-mail address of person who referred you:

Please list an Emergency Contact for yourself:

Name of Emergency Contact:

Phone number of Emergency Contact:

Your relationship to the Emergency Contact:

If your application is approved, we will notify you with mission expenses, and the deadline for payments.