MEDICAL KIT REQUEST FORM

Today's Date *
Today's Date
Phone *
Phone
Phone *
Phone
Fax
Fax
Not required to receive a Medical Kit, only necessary to receive certain medications.
Dates leaving and returning
Please note, your Medical Kit will not exceed this amount.
How will you be submitting your "Available Kit Items" list?

SHIPPING INSTRUCTIONS: A representative from your Church must come to the Caring Partners warehouse to pick up your Medical Kit. If you are unable to do so, email or call the Caring Partners office, and we can make shipping arrangements for your Mission Team. Please inform CPI of the address where items should be shipped via UPS.