Mission Application Forms

To participate in the next mission with Partners For Belize, please complete the online form on this page, or download the forms below and return by mail or fax. If you have difficulty of any sort, contact John Kirby at the following email: partnersforbelize@gmail.com

Apply by Mail:

Download PDF: Application for Belize Short Term Mission
Download PDF: Mission Statement Participation Form

Please fill out all fields.

Name as appears on passport

Name I go by for trip

Your Email

Date of Birth as it appears on passport

Phone/Cell

Trip Departure Date

I would like to fly from this city if not available, second choice is from this city

Tee shirt universal size

Emergency Contact Name

Emergency Contact Number

US Citizen or Country

Professional medical degrees if any

What is your sub specialty in your profession?

If you have a medical license, what is the type, number and state licensed?

What is your "day job" while back home?

Have you been to Belize or any other mission?

What is something you would like others on trip to know about you as far as a hobby or special interest, family you will leave while in Belize

The most important skill is being available, but do you have construction, medical, translation, music, or other skills (you never know what might be needed)?

Please upload a picture of yourself (jpg or pdf files only, and keep them under 2MB, please)

I want to stay extra days on this schedule:
Don't buy my airline ticket with group

Yes, I realize that Belize and the group I am volunteering to attend does not require vaccinations, but I am taking personal steps under my doctor’s guidance to travel to Belize in Central America as I weigh the personal risks of coming.
Yes

I have read and agree with the Mission Statement.
yes