Support NOAH NY

Thank you for your interest in NOAH NY Medical Mission! Please complete the form below and click Submit. Please also be sure to mail a copy of your license to NOAH NY at P.O. Box 24702, Brooklyn, NY 11202 or scan and email a copy to admin@noahny.org

Personal Information

In what capacity can you serve on our mission?

REMINDER: if you are an MD, PA, RN, LPN or other type of license medical personnel and you do decide to join us on our medical mission, we will need a copy of your license for our files.

Expiration Date

Expiration Date

Please select your year in school

Dentist License #

Expiration Date

PA License #

Expiration Date

Pharmacist License #

Expiration Date

Other Please list (i.e. translator)

Do you speak French or Creole?

You do NOT need to speak French or Creole to go on one of our trips, this is just for our information

Do you have any medical conditions that may interfere with travelling abroad? * This information is exclusively used for us to be aware of any conditions complicating travel for you or for use during an emergency.

YesNo

Are you a vegetarian?

Emergency Contact

Volunteer Service Agreement

By checking the ?I Agree? checkbox below, I hereby waive any right of recovery and release NOAH-NY, their officers, officials, employees and agents, from liability related to the undersigned, arising from any and all injury to persons and damage to property, and further agrees and undertakes to indemnify, hold harmless and defend NOAH-NY from and against any and all claims, damages, actions, liability and expenses including attorney?s fees and other professional fees in connection with bodily injury including death, personal injury and/or damage to property arising from or out of my activities and participation in volunteer services.

I also grant NOAH-NY and its agents the right to use my picture, voice, and other reproductions of my physical likeness in connection with advertising or publicizing NOAH-NY services and its activities in all forms of media in perpetuity.

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

LATEST NEWS AND EVENTS

Current Situation

Hurricane Matthew made landfall in Haiti on Tuesday October 4, 2016 with 145 mph winds, two feet of rain and storm surge, killing over 1,000 and displacing more than 60,000 people. The category 4 stor

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Howard University Hospital & U.S.-Based Haitians Responding to Haiti’s Continuing Struggle

Haiti, still struggling two years after a devastating earthquake, is getting needed health care assistance from Howard University and U.S.-based Haitian immigrants, the university medical school announced June 1. A team of 25 physicians, dentists and medical students and 75 non-physician volunteers are heading to the island nation to provide medical care and clinical training […]

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June 2 Sunday
Medical Mission
Go on a medical mission with us. Medical mission trips with NOAH NY provide short-term volunteer opportunities for medical and dental professionals, students, and non-medical volunteers with any level of experience. Our medical and dental clinic provides free healthcare and health education. View Event
May 22 Wednesday
Annual Gala
Our Annual Gala is more than just a party. It's a gathering of friends. It's an evening dedicated to giving back. It's an annual celebration of Haitians and Friends of Haiti, coming together to make a difference. Join our growing community of over 300+ guests including influencers in the medical field, development, tech, entertainment and art. View Event
President’s Message