J-Team Registration & Application Form General InformationToday's Date Name as on passport* First Middle Last Nickname or Preferred NameEmail* PhoneAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Passport NumberPassport Expires Date of Birth* Church AffiliationHealthHealth CategoryExcellentGoodFairHealth 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 PreferencesTrip Preference*AnytimeNovember 3-11, 2018February 2-10, 2019May 4-12, 2019August 3-11, 2019November 2-10, 2019Preferred area of service*Evangelism/TeachingMedicineClinical RecordsEncouragementBuildingTraining and/or experience that relates to area of serviceAttention: Medical ProfessionalsI can serve as:PhysicianNursePharmacistClinic Registrar/Records ClerkBecause of the nature of TEAMS, I understand that I will need to treat people outside of my specialty.* Agree Your medical specialtyHow did you learn about TEAMS for Medical MissionsAn 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 InformationGive the name of someone not traveling with you.Name* First Last Relationship to youAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneWork PhoneEmail* Safe Arrival NotificationA "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 ShirtGender Specific SizingSmallMediumLargeX Large2X LargeTerms & ConditionsTo help insure the most enjoyable and profitable ministry trip possible, please read and mark each of the following. I understand that...Please Check All* I am responsible for covering my own trip fees as set by TEAMS. The trip fee is $1,800. Contributions will be receipted as being for the work of TEAMS for Medical Missions and credited to my trip account. If there is a surplus after your trip fund is paid, it will be redistributed to other mission needs according to policy. My travel arrangements will be made by TEAMS for Medical Missions and paid for from funds I generate. Airfare is non-refundable and I can make no changes to the itinerary as arranged by TEAMS IRS policies require that once a payment or donation is receipted, non-profit entities such as TEAMS for Medical Missions cannot give refunds While there will be time set aside for sightseeing and recreation, this is primarily a work project involving teaching, evangelism, medical services, and construction. I might need to work in seasonable heat, carry light to moderate loads for short distances, climb steps, be on my feet, or ride in a vehicle on occasionally rough roads. A person who is older or has health concerns should realistically consider the physical demands of such a trip. J-Team members should avoid divisive theological arguments or political discussions. J-Team members should leave the USA and arrive back with the rest of their team unless prior arrangements are made in very special circumstances. During the trip J-Team members should attend all group meetings, prayer and devotional times, and planning sessions. By submitting this Application form I indicate that I have read and understood this form, the J-Team Policy on Refunds, and A Summary of Our Statement of Faith and will work in harmony with them. I am also responsible for information conveyed by other means such as the TEAMS Handbook and all email specific to my trip. Questions, Comments, NotesPhoneThis field is for validation purposes and should be left unchanged.