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Laboring in Mission to Neighbors in Need

Adult Emergency Medical Form & UMVIM Accident Insurance

Please Complete and FAX Promptly

1. Adult Medical Release and United Methodist Volunteers in Mission Insurance Form
      a. Print Adult Medical Release and UMVIM Forms
      b. Complete and sign both, NOTARIZING the Medical Release Form

2. Fax Completed Forms to "Attn: L4N:" at 214.953.1332

 

For an explanation of these Mission Documents, click here

 
To continue please answer the following question.
What is seven added to three?*
 

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Pay Online via Credit/Debit Card

Or print this page and mail a check or money order for the fee and send to:
Labor for Neighbors, Inc.
1601 Elm Street, Ste 4100
Dallas, TX  75201




** To complete an Online Form "pdf" document, click Medical Release Form Online. You must have Adobe Reader to open and utlilize the "fill in the blank" options. If you do not have Adobe Reader, it may be downloaded.  Please allow a moment for both the software and the file to download.