All medical and dental professionals hoping to volunteer for Bless Fest will be asked to present copies of their Photo ID, Current BLS Certification and Professional license at volunteer orientation on Thur. April 25th at 7 PM at New Hope Assembly of God 14000 Racho Blvd. Taylor (734) 287-4673.  We want to make sure you are covered under your malpractice policy and bring a copy of all required documents.

Bless Fest Medical Form

Please complete and indicate professional standing with support documents.

First Name:
Last Name:
Place of Business
Address:
City:
Zip Code: (5 digits)
State:
Daytime or Cell Phone:
Name of Malpractice Coverage:
Email:
List Title, Medical Training
and Care to be provided
at Bless Fest: