Fall Trip 2019: New Participant Application

November 2 to November 9, 2019 | Comayagua, honduras

Thank you for completing the form below. If you have questions, please contact Mary Ellen Gannon.

Name *
Name
Primary Phone *
Primary Phone
Alternate Phone
Alternate Phone
Date of Birth *
Date of Birth
Emergency Contact *
Emergency Contact
Stateside Volunteer Responsibilities
Pre-trip and post-trip activities are critical to the success of the Brigade. All participants are requested to participate in stateside volunteer opportunities addition to in Honduras. Please indicate activities you would be interested in. Prior experience is not required in many areas.
Honduras Healthcare Responsibilities *
Please indicate activities you would be interested in.
Please specify your specialty below if applicable.
Honduras Support Responsibilities
Please indicate activities you would be interested in.
Do you have previous experience in mission or other related work that may be useful in the Brigade? Please describe any relevant experience and the area in which you practice now.
How proficient are you in Spanish?
You must have a valid passport that will not expire within 6 months of our return to the US (in June of the year following the trip). Immunizations for hepatitis A&B, typhoid, tetanus, and prophylaxis for malaria are recommended. Do you have a valid passport?