Bausch Foundation MEDICAL MISSION PROGRAM

Bausch Foundation
Medical Mission Program Application
Rx Pack

 Please note, you must complete the forms and submit them properly before your application is complete. Expedited service to meet travel deadlines and deliveries to Alaska and Hawaii incur additional charges.

Partner Organization Information

Click on the buttons below to complete each form separately or select the bottom link to complete both. Both the Eligibility Packet (Partner Organization Information) and Practitioner's Agreement must be completed before shipments are approved.

Eligibility Packet Form

PopInBlue_ELS_Eligibility Packet Form

Practitioner's Agreement Form

PopInBlue_ELS_Practitioners Agreement Form

Eligibility Packet with Practitioner's Agreement

PopInBlue_ELS_Eligibility Packet Form with Practitioners Agreement

Please complete, sign and submit the following 4 forms and a member of the MAP Team will be with you shortly. Please note, you must complete all 4 forms and submit them properly before your application is complete. Expedited service to meet travel deadlines and deliveries to Alaska and Hawaii incur additional charges.

 Have Questions?

MAP's Customer Service team can be reached by phone at 1.800.225.8550 Monday thru Friday - 8am to 5pm (EST) 

 
bf_logo_new-colors

CONTACT

PRESS KIT

VOLUNTEER

CAREERS

WAYS TO GIVE

FINANCIALS

OUR LEADERSHIP

PRIVACY POLICY

CUSTOMER SERVICE

ECFA Charter

 Global Impact

 
Better Business Bureau
Forbes

Get Hope in Your Inbox

CONNECT WITH US
MAP Intl Facebook MAP Intl Twitter MAP Intl LinkedIn

From Our Blog

map-logo

© 2019 Copyright MAP International | 4700 Glynco Pkwy, Brunswick, GA 31525 | 912-265-6010 | map@map.org