We invite you to share in the wonderful privilege of caring for the poor and sick in Honduras, Nicaragua, Haiti and
Africa!   Please fill out and submit the application below to LOTWC,  sending in your supporting documentation either
via email,  fax or mail. 

Your name will be added to the list of volunteers willing to participate on medical missions abroad.  Please understand
that each team is chosen according to the needs of the people we serve.  Filling out an application does not guarantee a
place on an actual mission team.  Once teams are assembled they will be go before the Board of Directors for final
approval. 

Although not always possible, we do our best to contact chosen team members 4 to 6 months before departure date of
each trip to confirm their availability to participate.   As much as we try to place team members that want to travel
together on the same mission trip,  it is not always possible.  Please take this into consideration when filling out your
application.

Expenses for team members are paid by Light of the World Charities with the exception of the Africa Mission Trip.
"Africa Team Members are responsible for 100% of all airfare costs and cost of any optional excursions, along with
a 2 week time commitment."

Team members residing outside of Florida are responsible for airfare to and from Miami, which is tax deductible.
*Please note:
In addition to this application, you will have to either attach, fax or send the following to;

LOTW offices FAX 772-600-1941
Address: PO Box 273 Palm City, FL 34991
  • A current resume
  • Copy of your license, certification and diplomas
  • Color copy of your passport (Must be sent from a color capable Fax Machine, email or regular mail)
  • Physicians must submit diplomas from medical school and your school of surgical specialty
Light of the World Charities Volunteer Application
(Medical and Non-Medical Volunteers please utilize the same application)
NewButtons.vbprj Vertical Css Menu by Vista-Buttons.com v4.5.0
First Name: *
Middle Name *
Last Name: *
Address: *
City: *
State: *
Zip: *
Home Phone: *
E-mail Address: *
Work number *
Cell Number: *
Fax Number
Date of Birth *
Select Date
Professional Title: *
Area of Speciality: *
Professional/Character Reference #1: *
Address: *
Phone Number: *
E-Mail: *
Professional/Character Reference #2: *
Address: *
Phone Number: *
E-Mail: *
Professional/Character Reference #3 *
Address: *
Phone Number: *
E-Mail: *
Are you fluent in any other foriegn languages?
Please list any other community experience:
Please list any previous overseas experience:
Please list any other travel experience:
What is your religious affiliation?
Health History:
Heart or Lung Problems
Diabetes
High Blood Pressure
Allergies
Other
Medications
If you checked Other or Medications above please explain:
In Case of Emergency Notify: *
Relationship: *
Emergency Number: *
How did you hear about LOTWC? *
Why do you want to volunteer with LOTWC?
I am willing to accept the responsibility of preparing, acquiring supplies/materials, and assist in fundraising, for the missions I am chosen for, prior to the departure date. *
YES
NO
I am willing to travel to the following countries: *
Africa (Africa Team Members are responsible for 100% of all airfare costs and cost of any optional excursions, along with a 2 week time commitment.).
Haiti
Honduras
Nicaragua
NONE I wish to volunteer in the Palm City Office
NONE I wish to volunteer in LOTWC Free DENTAL CLINIC located in US
I am willing to travel on MORE than one mission per year. *
YES
NO
How many years have you worked in the OR?
How many years have you scrubbed?
How many years have you circulated?
How many years have you worked in the Recovery Room or ICU?
I am CNOR Certified. *
YES
NO
I have other certifications which include the following:
Attach a Supporting Document:
I hereby affirm that the above information is accurate and complete. (please type your name in the box provided: *
Date: *
Select Date
Verification Code:
Enter Verification Code: *
* Required





Mailing Address
PO Box 273
Palm City, Florida 34991
© 2010 Light of the World Charities
All Rights Reserved



Office Address
3533 SW Corporate Park
Palm City, Florida 34990
Main Office Phone: 772-221-4688
Dental Clinic Phone: 772-600-5510
Light of the World Charities is a 501(C)(3) non-profit organization recognized by the IRS.
All donations are tax deductible in accordance with IRS regulations.
Join Us On facebook
Join Our Mailing List
Volunteer Application
Fax: 772-600-1941
Email: lotwcfl@comcast.net