Medical Team Application

Step 1 of 2

  • Medical Team Application

    If you are requesting supplies from Advocates for World Health to carry as extra baggage on an overseas flight, or if you would like to receive a domestic shipment of less than a container load for use overseas, please fill out the application below.

    1. Your Destination

    Please provide information about the institution, facility, or location where you will be utilizing the donated supplies.
  • 2. Primary Contact

    In the section below, please provide information about the primary contact for this donation. Advocates for World Health may contact this person to schedule an appointment to pick up the supplies, or to coordinate shipping or the supplies if necessary. A thank-you letter for any sponsorship donation given to Advocate for World Health will be sent to the address provided here unless otherwise requested.
  • 3. Medical Professional Responsible for the Supplies Received

    In the following section, please provide the requested information about the medical professional, either traveling or at the destination facility, who will take responsibility for the donated supplies. If there is no medical professional associated with your trip, Advocates for World Health may limit the types of supplies we can provide. If the medical professional responsible for the supplies received is the same as the primary contact person, you may skip this section.