SMI Application

SMI 2025 Application
Location: South Africa
Dates: May 1-11, 2025
Total Cost: $3,000

* Indicates required field

Full Legal Name (First Middle Last) as it will appear on your passport: *

Name you go by *

Email *

Phone Number *

Date of Birth *

Gender *

Male Female

Emergency Contact *

First

Last

Emergency Contact Relationship *

Emergency Contact Phone Number *

Emergency Contact E-Mail *

I'm applying as a *

Healthcare Provider Healthcare Student Other

Your specialty/ field of study (and anticipated year of graduation)/ who you are if not in healthcare *

How did you hear about this trip? Who are you connected with among the MCO Charleston community? *

Why do you want to go on this trip? *

Do you consider yourself a Christian? What is your short testimony or experience with Christianity? (This is by no means a requirement for the trip. We welcome all to join us! But being that the trip is specifically a Christian outreach, it's helpful to know where team members are coming from.) *

Do you have any specific talents or gifts that may be a benefit for the team? *

Food Allergies *

Health conditions that our medical team should be made aware of. Specifically, any conditions that would limit your participation in team activities during the trip. *

Do you have any questions or comments for the team leaders as we build this team and prepare for the trip? *

Today's Date *

Please type your name below as your signature promising that all of the above is accurate and true. *

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SMI 2025 ApplicationLocation: South Africa​Dates: May 1-11, 2025Total Cost: $3,000

SMI 2025 Application
Location: South Africa
Dates: May 1-11, 2025
Total Cost: $3,000