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 Volunteer Application

YOU MUST HAVE A SCANNED COPY OF YOUR signed Passport, Medical License and Medical School Diploma and Board Certification (if applicable) prior to beginning your application as you will be required to upload these documents before you can submit your application. Please read each header before filling in the information requested. All items with an * must be filled in; if not, the application will not be accepted by the server.

Team Leader/Organization/Church

Passport Information

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YOU MUST UPLOAD A COPY OF YOUR PASSPORT

Please call the Director of Field Support at Lumiere if you do not have access to a scanner. 704-823-0271

Emergency Contact and Travel Insurance

EMERGENCY CONTACT
Insurance Beneficiary (cannot be self) and relationship to Volunteer
Please keep me connected with LMM via e-mail *
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Lumiere Medical Ministries, Inc. 510 W. First St. * P.Box 26* Lowell, NC * 28098
tel. 704-823-0271
 
 
 
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