Team Application Form

Please fill out the application below to be considered for an upcoming team. Make sure you identify which team you are interested in traveling with. You may only apply for one team per submission.

NOTE: Passports must be obtained prior to departure. Once you have obtained a passport, please email a color scan of your passport to the Operations Coordinator: Monica C.Holgen:

Team Applying For
Professional Information

Language Skills:

For Medical and Licensed Professionals

Please email a copy of your resume or CV and your medical/dental license if applicable to This information is needed to fully evaluate your application.

Passport Information
Contact Information

List address where you can receive mail and packages:

Emergency Contact

Please make sure that you have checked over all of your information in the above form and that it matches the information on your passport. Airline tickets will be based off of this information and any errors submitted may result in additional costs at the applicant's expense. Check this box to verify that your information is valid and that you are aware of the consequences that may ensue if information is incorrect.

Initial Donation

Please note: **Your application is not complete without an initial $300 donation**

There is a $300 donation due when you submit this application. If selected as a team member this fee will be applied as a donation toward your trip and is non-refundable. In the event that you are not selected for this team you have the option of either a refund of the full donation, you can apply this donation toward another PHH trip or you can donate these funds to the PHH general fund.

Payment Details

Your total amount is $.

CVV2 Info
Additional Comments


Powered by