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All disciplines
within
Medical, Dental,
Chiropractic, Optometry, Audio logy, Pharmacy
NEW OR RENEWAL MEMBERSHIPS
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Member Information
(Application) Form, Rev. 7/08
(required annually) |
download
PDF
|
print copy and mail |
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Release of Liability Form
(required annually) |
download
PDF |
print copy and mail |
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Professional
Resume' (CV) (required one time only) |
complete
On-line |
submit via our website |
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Current Professional License
(required -- please remember to send us updates) |
Mail legible copy with application
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Include a
check for $35, single, or $45, family and Mail.
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Go on-line to
complete our Trip Preference form.
Let us know
which trips would fit best with your schedule
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complete
On-line |
submit via our website |
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Contact the
coordinator of your Specialty -- Specialty
Coordinators --and introduce yourself. Our Coordinators
are volunteers (non-paid) who hold down full time 'regular' jobs and may not have noticed your name appearing on the
membership list. We don't want to miss you, so please give us a call
or send an email. |
Licensed Professional Providers:
Chiropractic - Patricia Henthorn -
docPatti@cox.net
Dental - Corinna McClure -
samsrdh@mac.com
Medical - Gail Brown -
gbflyingnp@cox.net
Optometry - Amy Crump -
CrumpAmy@hotmail.com
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FlyingSamaritans