Friends of Haiti Medical Mission Trip Application Form
INSTRUCTIONS: Please complete this application form for consideration for the Friends of Haiti Mission Trip.
- Once complete, click the “Submit” button and your completed form will be emailed directly to Professor DeMuth.
- The application deadline is 4:00 p.m. on Monday, April 23, 2018.
- Please contact Professor DeMuth, Travel Course Facilitator at 920-433-6671, Office Room 231, firstname.lastname@example.org or Ann Wasmund, Travel Course Administrative Assistant at 920-433-6628, Office Room 109, email@example.com should you have any questions or concerns.
Please provide the following required information.