Online Registration Form | YWAM Medical Ships Australia

This form should take you less than 30 minutes to complete. If you don’t have the time to fill it out right away feel free to just submit the form with some of the information missing, and we will contact you to get all the information we need to proceed with your registration form.
Download the Outreach Info and Volunteer Registration Pack if you want to fill it out offline.

Thank you for wanting to volunteer with the YWAM Medical Ship.

Filling out this Registration Form is the first step to register for a position on Outreach.

It should take you about 15-20 minutes.

Once this portion of your registration is received, we will email you a link to complete the second portion of the online Registration Form and a link for the online Reference Form.

First Name *

Last Name *

Position registering for: *

Please specify

Outreach Details

(If you are flexible with your time frame, please select any outreaches that would work for you)

2013 Outreach(es) registering for: * Outreach 1 - 9 May - 26 May
Outreach 2 - 30 May - 16 June
Outreach 3 - 20 June - 7 July
Outreach 4 - 20 July - 28 July
Outreach 5 - 1 August - 18 August
Outreach 6 - 22 August - 8 September
Outreach 7 - 12 September - 29 September

Are you a returning volunteer? * YesNo

Welcome to our Online Registration Form.

Please fill out all fields to speed up the registration process.

If you have any questions during the registration process please do not hesitate to contact us and save your progress as you go. Another option is to download a hard copy here and mail, fax or email it to us.

Personal Details

Preferred Name

Middle Name

Sex MaleFemale

Birthdate Please enter the date in the following format day/month/year 28/10/1980 04/01/1990

Birthplace

Shirt Size * (Australian sizes: Women's Sizes: 8, 10, 12, 14, 16, 18, 20, 22, etc.; Men's Sizes: S, M, L, XL, 2XL, 3XL, 4XL)

Shirt Size Chest

Shirt Size Waist

Marital Status

Spouse's full name

Spouse's Birthday

Will your spouse be accompanying you? YesNo

Will any children be accompanying you? YesNo

Name

Birthdate Please enter the date in the following format day/month/year 28/10/1980 04/01/1990

Gender

Please upload a recent photo of yourself

Mailing Address

Street

City / Town *

State / Province

Post Code / Zip

Country *

Is your permanent address the same as your mailing address? YesNo

Permanent Address

Street *

City / Town *

State / Province

Post Code / Zip * Zip is your Postcode

Country

Phone (Home) * Please include your country and area code. E.g 001 425 8889 472 or 0061 7 4771 2123

Phone (Mobile)

Email *

Passport / Visa Information

Country of Citizenship

Do you currently hold a valid Passport? YesNo

Expiry Date Please enter the date in the following format day/month/year 28/10/1980 04/01/1990

Passport Number *

City and Country of Issue *

Do you currently hold an Australian Visa? YesNoNo, I am an Australian / NZ citizen

Visa Type

Visa Expiry Date Please enter the date in the following format month/date/year 10/28/2010 01/04/2010

Do you currently hold a PNG visa YesNo

Visa Type

Visa expiry date

Church Information (if applicable)

Home Church

Pastor First Name

Last Name

Denomination

Mailing Address

Phone Please include you country and area code. E.g +1 425 8889472 or +61 7 4771 2123

City / Town

State / Province

Post Code / Zip

Country

Medical Personnel Only - Please provide for Professional Registration and Administration

One certified /notarized copy or your current practising license/certificate (in English)

Copy of a "Certificate of Good Standing" from your Professional Registration Body not older than 3 months from the date of this application. Allied health Staff do not need to obtain this.

Additional Information

Please write any health issues, or any other information pertinent to this application thaty has changed since your previous application

Criminal Record

Have you ever been convicted of a felony? YesNo

When and where? *

Have you ever been convicted of a sexual crime? YesNo

When and where? *

What most influenced your decision to register?

What training or experience have you had that could be included with the YWAM Medical Ships?

How did you first hear about YWAM Medical Ships?

As we are a faith based organisation, if applicable, please share your personal spiritual beliefs. *

Registration Fee:

A 20 AUD registration fee is required upon receipt of registration. It cannot be processed otherwise.

After submitting your registration form you will be redirected to our payment page.

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