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  • Home
  • About Us
    • Where We Go
    • Meet Our Team
    • Contact Us
  • Medical Missions
    • Apply for a Mission
    • Where are we going?
    • Mission Photos
  • LI Events
  • Support a Volunteer
  • Junior Volunteers
  • Shoppe
    • Blanca’s House Merchandise
  • Giving Tuesday
  • My Account
    • Pay Mission Fees
    • Account Login

Register for a Mission

Registration Form

*All fields are required. Please mark the field with n/a if it does not apply.

Cost is round trip air from JFK only, transfers, tips, emergency evacuation insurance, hotel and meals. Alcoholic and non-alcoholic beverages are not included in mission cost. Team members departing from other cities will receive an adjusted rate.

"*" indicates required fields



DISCLAIMER:
Blanca’s House is not responsible for any change(s) to the location of a medical mission due to the host government’s decision to relocate the site of delivery of medical services based on their review of need.
Please select the mission that you are interested in attending:*
Mission Cost: $2,116.00 (Single occupancy) / $1,996.00 (Double occupancy)
Consent*
*
Name*
For example, if you are a Nurse and you work primarily in the OR, then that would be your area of focus.
Current Place of Employment/Current University or College of Study:
MM slash DD slash YYYY
Are you under 18 years of age?*
Children under the ago of 18 must be accompanied by a parent.
Please provide contact information for your parent that will be attending the mission with you:

Mailing Address*
Email*
Password*
Please remember your password. If you are accepted into the mission, you will need this to log in and complete the application. THANK YOU
Accepted file types: pdf, Max. file size: 128 MB.

MM slash DD slash YYYY
You will receive an email with link to the application once your reservation is submitted.
This field is for validation purposes and should be left unchanged.
33 Walt Whitman Road, Suite 232
Huntington Station, NY 11746
info@blancashouse.com
  • 1 (631) 923-1053
  • 1 (631) 923-3006
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Blanca’s House is registered as a 501(c)(3) non profit organization. Contributions to Blanca’s House are tax deductible to the extent permitted by law. The tax identification number for Blanca’s House is 26-1338765

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