Mission Trip Request Form

Please fill out all parts of the form below to complete a request.

Step 1 of 5

  • Your Contact Information

Notes about the Mission Trip Request Form:

The Team Leader is the name of the person leading the team for this trip. We create a file for this trip identified with the team leader’s name, and all the correspondence about the trip is addressed to that person. If we have questions, we’ll call that person first. Any questions regarding this trip should be made with reference to the team leader’s name or the trip ID number.

The Physician with your Organization/Ministry is the Doctor listed with your organization/ministry and who has sent us a copy of his/her current license and accepts responsibility for the medications and medical supplies for your mission trip.

The Pack Date is optional for those who need to pack or receive paperwork earlier than a week before the trip date. You may give us a pack date that is two or three weeks before your trip, or even several months before you leave on your trip.

The Pack Date, Trip Date, and Return Date  must be greater than 3 weeks from the current date.

Country of Mission is the destination country for your trip. It is helpful if you also include the city or district of your destination.

Shipping Information should be the physical address and person the medications for this trip should be shipped to. This can be the team leader, but can be anyone else the team leader designates. Trucking companies do NOT accept P.O. Box numbers for shipping as a delivery address. The phone number is also important – some truck lines will not deliver without it.