India Medical Mission 2020 event registration

Please enter information in the form below to process registration for event India Medical Mission 2020.

Have you been on a Medical Mission with GAiN Australia before?

If you prefer to apply via a paper form, please download here (Choose yes or no above first) and print it.
Then post it to us at PO Box 674, Merrylands, NSW 2160.

Personal Details

First Name *

Middle Name

Last Name *

Is this your legal name? (Name as per PASSPORT) *

Date of Birth *

Gender *

Marital Status *

Contact Details

Address *

City *

State *

Country *

Postal / Zip Code *

Preferred Email *

As all future communication and emails will be sent to this address, be sure to check that it is correct.

Mobile Phone Number *

Please write this in the following format xxxx xxx xxx. E.g. 0404 121 114

Passport Information

Passport Number *

Passport Nationality *

Passport Expiry Date *

Additional Details

Occupation *

Name of Church (if applicable)

Referee Name *

Referee Contact Number *

Emergency Contacts

Emergency Contact 1 - Name *

Emergency Contact 1 - Phone Number *

Emergency Contact 1 - Alternate Phone

Emergency Contact 1 - Relationship *

Emergency Contact 2 - Name *

Emergency Contact 2 - Phone Number *

Emergency Contact 2 - Alternate Phone

Emergency Contact 2 - Relationship

About You

What prompted you to go on a medical mission? *

What are your expectations of this mission? *

Are you a Christian? *

When and how did you become a Christian? (please do not exceed 150 words) *

How committed are you to reading God's Word and prayer? *

Please describe your (a) strengths, (b) ministry gifts or skills, and (c) spiritual gifts *

In what areas do you still desire growth? *

Are you willing to do what is required of you during the mission trip? *

Do you have any condition/s which may limit you, such as serious allergies requiring medication, depressive/mental illness, limited mobility, extremely poor eyesight, hearing loss, severe asthma, chronic fatigue, food intolerances, etc? *

Please give details of your condition/s and limitations *

Are you currently or have you been under a doctor or psychiatrist's care in the past 2 years (apart from minor ailments)? *

Will you need any special food requirements? Please list medical requirements only, not preferences *

By clicking proceeding, I declare that to the best of my knowledge, all the information in this application is true and complete

Verification code*

Apply to join India Medical Mission 2020