World Medical Mission

Community Medical Outreach Volunteer Interest Form

Name(Required)

First Last

Medical Title

Address(Required)

Street Address Address Line 2 City State Zip Code

State of Residency(Required)

State

Email(Required)

Phone(Required)

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Samaritan’s Purse is a 501(c)(3) tax-exempt charity. All contributions designated for specific projects shall be applied to those projects, and we may assess up to 10 percent to be used for administering the gift. Occasionally, we receive more contributions for a given project than can be wisely applied to that project. When that happens, we use these funds to meet a similar pressing need.

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