Returning Doctor

If you are returning, the documents below are required.

$100 deposit due by 3/5/20 to reserve lodging room.
Remaining balance due 5/4/2

The deadline to turn in all other forms to stefaniemaze@atsu.edu is May 4, 2020.

You will also need to fill out the online “Jamaica Dental Mission Form” below.

If you have any problems submitting the form, please contact Stefanie Maze at stefaniemaze@atsu.edu.

 

 

 

 

 

  • Certified copy of current license

 

  • 1 photographs (passport size)