Volunteer Information

Trip Dates*
  • Future Trip

(The March & July 2019 Medical Trips are now full.)

Medical Specialties*
  • Veterinary Medicine
  • Prayer
  • Nursing
  • Physician
  • EMT
  • Dental
  • CPR/First Aid
  • Therapy
  • Nurse Practitioner
  • Physician's Assistant
  • Med Team Support
  • Other Skill or Interest - please note in comment field at end of form
If so, what degree program?
Year of expected graduation?

Contact Information

Country*
State / Province*
Address*
City*
*
*
*
*
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Email*
Confirm Email*
Mobile Phone*

Travel Information

All trip participants are required to have medical insurance coverage in Malawi. If your health insurance does not provide coverage outside the US, you are responsible to obtain appropriate traveler medical insurance prior to your trip.

Health Insurance Provider*
Health Insurance ID*
Name on Passport*
Passport #*
Passport Expiration Date*
Country of Citizenship*

Trip Payment Information

A total of $1,200 in grounds fees is due to VIP, including a $500 deposit. *This amount covers expenses while on the ground in Malawi, but does NOT include airfare or insurance.*

Trip Payment*
  • I will mail a check to VIP.
  • I will pay online with a credit card.
Additional Comments

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