2018-2019 Global Medical Brigades- Honduras Application
Global Medical Brigades Application: Winter 2019

Welcome to GMB's application to become a brigader on our trip to Honduras from January 6-12, 2019!

Applications are open now and will close on October 8 at 11:59pm.
All applicants are accepted on a rolling basis. You will hear within a week if you have been selected. If selected, all participants must also register for a personal fundraising account on our GB brigade page and participate in group fundraising events: work beer portable at 1 Raven's Game, and sell 5 International Trivia Night tickets and actively volunteer in a committee to help collect medications/dental/hygiene supplies.

The payment schedule is as follows:
Within one week of acceptance (or by Oct 8 - $250 total (non-refundable deposit) payable to @GMBatUMB or check
November 5th (may be subject to change) - $800 total (or full airfare amount) due in your account on GB brigade page.
December 21st (may be subject to change) - Final balance due in your account on GB brigade page.

Total cost of the program is around $1600-$1800 and is directed towards flight, in-country expenses, meals, lodging, security and transportation. There will be opportunities to help pay for the expenses of the trip.

You must have a passport to go on this trip. If you do not have one, there is still time to apply and get one, but you must do this as soon as possible.

*If the application is turned in on Monday Oct 8th, the applicant must deposit the initial $250 on the same day. Apply early!

For any questions or concerns, please feel free to contact Ching Chen at ching.chen@umaryland.edu

Please enter your full name as it appears on your passport *
Sex *
Preferred Email Address *
Please use the best one for contacting you with important GMB updates.
Phone Number *
xxx-xxx-xxxx
Address *
Country in which you currently hold a passport or travel document *
If you do not currently have a passport, please contact the GMB president as soon as possible.
Emergency Contact Name *
Please list the person you would like us to contact in case of an emergency. This person will also receive a complimentary email when you take off and land from your port of departure/arrival as a courtesy of the airline.
Emergency Contact Relationship *
Emergency Contact Phone Number *
What school are you in? *
Anticipated Graduation Year *
Specify Other^
Special Dietary Restrictions
i.e. vegan, vegetarian, lactose intolerant. This will not disqualify you, but we need to know this ahead of time so that proper accommodations may be made.
Health Conditions
i.e. asthma, diabetic, factor V leiden. Please let us know if you have any medical or health conditions that will need special attention on the trip should an emergency arise.
Spanish Language Ability *
Note: this does NOT impact whether you will be invited to be a brigader, this is strictly for informational purposes.
Why do you want to come on a Global Medical Brigade to Honduras? *
You might also include what you feel you can contribute to our Brigade.
Have you had any similar experiences abroad? *
Special Training/Knowledge
If applicable, please indicate any special skills you have that may be an asset on the trip.
If chosen, do you plan to fly out of Baltimore/D.C. area en route to Honduras? *
If you do not plan to leave from this area and you know where you would like to fly out of, please indicate that airport by choosing "Other" and typing it in. Note that this may result in higher plane costs
I acknowledge that I am aware that if I am chosen and I commit to becoming a brigader, that I am responsible to put down a non-refundable $250 deposit. Additionally, if I commit to a position on this brigade, I am responsible for getting a passport and all required vaccinations in time to attend the brigade *
Comments
If you have any additional comments or questions for the GMB Executive Board, please include them below.
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