Volunteers In Medical Missions

Please use this form to submit an application for one of our fundraiser events. Just a few basic informational items that are needed. After completing the form, you can send the payment amount directly from our home page by clicking on the Donations link. If you prefer to mail a check, that is also acceptable.

Thank you for being a part of our fundraising events and for supporting the work of VIMM.

Event Name
Event Date
Participation Details
First Name:
Last Name:
Street Address:
City:
State:
Zip Code:
Cell Phone:
Email Address:
Date of Birth
Gender:
Church Name:
Team Name:
Shirt size:
Average Golf score or handicap:
Total amount to be remitted:
Payment remitted via: