Support MediNova NY

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

    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