Mission Trip Registration

Romania Medical 2026

The team will be working alongside local Romanian churches to provide basic medical care as well as sharing the good news of the Gospel through evangelism. The team will consist of both medical professionals (doctors and nurses and support team members who will function as evangelists, set up crew, and intake staff.


6/5/2026 - 6/15/2026
$4,000.00
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Additional Information

Please fill out the application below.
*Do you have a passport?:
*First Name as shown on passport:
*Middle Name as shown on passport:
*Last Name as shown on passport:
Suffix as shown on passport:
*Passport Number:
*Expiration Date:
*Gender:
*Date of Birth (mm/dd/yyyy):
*Social Security Number:
*Driver's License Number:
*State Issued:
Alias Name (put N/A if not applicable):
*Emergency Contact Information:
Emergency Contact Information #2:
:
*Health Insurance Provider:
*Policy Number:
*Full Name of the Insured:
:
List any medical restrictions/disabilities.:
List medical care received in the last 12 months.:
List allergies (including food):
List history of any major illness or surgery.:
What medicine are you currently taking?:
*Are you pregnant?:
If pregnant, how far along?:
:
*Why do you want to participate in this trip?:
*How do you want to grow from this trip?:
:
*Describe how you came to Christ?:
*What are your spiritual gifts?:
As a volunteer under [CHURCH NAME], I agree to pay all costs related to my trip such as immunizations, travel, food, lodging, and miscellaneous costs, and to serve without remuneration. I will be responsive to the counsel and suggestions of the Mission Te:
*Digital Signature 1:
I understand that by completing and turning in this application that I am applying to be a member for the above stated mission trip. Completion of this application does not guarantee my acceptance as a member of the mission team for which I am applying. I:
*Digital Signature 2:
*Digital Signature (First, Middle Initial, Last):
:)