Volunteer Application

Completing this application is the first step toward participating in a MMA medical mission team. If you are selected, MMA will contact you and request additional documentation and a nonrefundable deposit of $200 within 30 days to hold your spot. If you are not selected, you will be placed on a stand-by list. Preference is given on a first come first serve basis, with priority given to those living in Missoula and the surrounding areas, those with the specialties that are needed, and may depend on previous MMA experience.

You must have a passport before applying.

Important! Please enter your first, middle, and last names exactly as they appear on your passport. All fields are required to be filled out for submittal. If you are waiting to receive your passport or professional license, please note this in the Special skills or additional information field below.

Page 1 Page 2 Page 3 Page 4

Salutation: Select... None Mr. Mrs. Ms. Dr. First Name (As on your passport): Middle Name (As on your passport) Last Name (As on your passport) Do you currently have a Passport? Select... Yes No If yes, when is your expiration date?(if No, enter NA) Name you go by Date of Birth       Gender Select... Female Male    Citizenship Profession