New J-Team Registration Form | Teams for Medical Missions

General Information

Today's Date

Name as on passport*

First Middle Last

Nickname or Preferred Name

Email*

Phone

Address*

Street Address Address Line 2 City State ZIP Code

Passport Number

Passport Expires

Date of Birth*

Church Affiliation

Health

Health Category

Excellent
Good
Fair

Health Concerns (details)

We ask that you not apply if you have a physical problem that would be life-threatening if it were to occur in Jamaica during a J-Team.

Contact us if you have any of these*

Significant allergies
Physical challenges
Dietary restrictions
None of the above

Preferences

Which team fits your schedule and what area of service are you suited for?

Trip Preference*

Anytime
May 7-15 2022
August 6-14, 2022
November 5-13, 2022
February 4-12, 2023

Preferred area of service*

Evangelism/Teaching
Medicine
Clinical Records
Encouragement
Building

Training and/or experience that relates to area of service

Attention: Medical Professionals

I can serve as:

Because of the nature of TEAMS, I understand that I will need to treat people outside of my specialty.*

Agree

Your medical specialty*

How did you learn about TEAMS for Medical Missions

An internet search, or through a former J-Teamer, a TEAMS missionary, pastor or church leader (optional - name, phone number, email address), or some other way?

Emergency Contact Information

Give the name of someone not traveling with you.

Name*

First Last

Relationship to you

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Work Phone

Email*

Safe Arrival Notification

A "safe arrival" email will be sent back home upon your arrival. Please designate to whom you want this sent, if different from above.

Name*

First Last

Email*

TEAMS Polo Shirt

If this is your first J-Team in the past 3 years please choose a size below. If not, and you would like to have another shirt, please contact us at: teams@t4.org

Gender Specific Sizing

Terms & Conditions

To help insure the most enjoyable and profitable ministry trip possible, please read the following fine print. If you are in agreement with each statement, please check the corresponding box.*

Questions, Comments, Notes

Name

This field is for validation purposes and should be left unchanged.

TEAMS for Medical Missions

610-398-0070

If you've never been on a J-Team before, or if it's been more than two years since your last J-Team, please fill out the form below. Otherwise complete the Returning J-Team Registration Form.

General Information

Health

Preferences

Attention: Medical Professionals

How did you learn about TEAMS for Medical Missions

Emergency Contact Information

Safe Arrival Notification

TEAMS Polo Shirt

Terms & Conditions

Questions, Comments, Notes

TEAMS for Medical Missions

610-398-0070 teams@t4mm.org