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International Peace Team Application
ALL RESPONSES ARE CONSIDERED CONFIDENTIAL
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* Indicates required question
Email
*
Your email
Full Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Name as it appears on passport:
*
Your answer
Passport #
*
Your answer
Passport expiration date:
*
MM
/
DD
/
YYYY
Insurance Company Name:
*
Your answer
Name of Policy Holder
*
Your answer
Contract Number
*
Your answer
Plan Code:
*
Your answer
Group Number:
*
Your answer
PLEASE NOTE: Following your submission of the completed application form, you commit to mailing/emailing MPT the 3 mandated pieces of documentation listed here. To email, send to
MetaPeaceTeam@gmail.com
To snail-mail, send to
Meta Peace Team
201 W. Miller Rd.
Lansing, Michigan USA 48911
*
1. A photocopy of your Driver's License and/or other officially recognized I.D.
2. A photocopy of the front page of your Passport.
3. A copy of your health insurance card or verification
Required
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