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WILLAMETTE MEDICAL TEAMS
INTERNATIONAL APPLICATION
Name: Sex: Age: Birthdate:
Street Address:
City: State: Zip:
Phone (with area code): Work Phone:
Marital Status: Spouse’s name:
Dates of the team on which you wish to participate:
1st preference:
2nd preference:
Present occupation:
Do you attend church regularly: □ Yes □ No Name of Church:
Street Address:
City: State: Zip:
Pastor’s name: Work Phone:
Do you have any ongoing medical problems: □ Yes □ No
List your educational background:
Can you please describe your relationship with God right now and this relationship impacts your life?
Have you had previous mission experience? □ Yes □ No Please list where, how long and the nature of your work:
Why do you want to go on this mission?
How did you hear about our organization?
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