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C.U.R.E. Clinics International Medical Mission Trip Participant Application

We are always accepting applications for our international C.U.R.E. Clinics trips If you are a medical provider (physicians, nurse practitioners, and physician assistants) or other medical professional interested in joining us we would like to start a conversation with you.

Have questions? Please email us at [email protected].

Trip Participant Information

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Address

Address(Required)

Additional Information

Are you a returning Project C.U.R.E. international travel participant?(Required)
Are you currently under a doctor's care?(Required)
Are you currently taking any medications?(Required)
International trips can be emotionally and physically challenging.(Required)
Emergency Contact Address(Required)
I certify that my international flight arriving in the final destination for the trip lands at or before the required time as indicated on the “Suggested Flight Itinerary” document. I agree to meet the trip leader at the baggage claim of the airport, unless I am otherwise notified. If my flights are delayed for any reason, I will notify the Trip Leader and Project C.U.R.E. Travel Department as soon as possible. If I fail to arrive in-country at the required time, I will be responsible for any additional transportation and/or accommodation costs my late arrival causes.
International Flight Agreement(Required)
Project C.U.R.E. will provide travel insurance including medical evacuation coverage for all participants unless you specify here that you already have this coverage.
Do you have international travel insurance?
​​​​​​I understand that my participant program fees are a non-refundable donation to Project C.U.R.E. Should I need to cancel my trip, or the trip is canceled for any other reason, I understand that I may use funds paid as a credit for future C.U.R.E. Clinics.

I CERTIFY that all statements and information furnished in this Statement are true, complete, and correct to the best of my knowledge and belief, and are made in good faith. I understand that statements or information furnished on this form are subject to verification and I agree to furnish supporting documents or information when so requested and/or names, addresses, and phone numbers (if known) of officials or other individuals who can substantiate the qualifications described above. I also understand that intentional misstatements or falsification will result in disqualification.
Agreement to certify all statements are true, complete and correct.(Required)
The information provided in this application will not be shared outside of Project C.U.R.E. Your personal health information will only be used for purposes related to function and safety of Project C.U.R.E. clinic trips. 
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Thank you for your interest and for applying. Your application will be reviewed and we will contact you within 2 weeks.

At the heart of Project C.U.R.E. are people like you who are willing to get involved by donating or volunteering. Together we can change the world!

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