Already have an account? Sign in

Organization Application

Apply to join Kingsway Charities' medicinal supply program. Complete all four steps below.

Your Info

Organization

Physician

Confirm

Personal Information

First Name *

Last Name *

Email *

Phone *

Your Position at the Organization *

Address *

City *

State *

Zip *

Organization Information

Legal Name of Organization *

Website (include https://) *

EIN *

Address *

City *

State *

Zip *

Primary Contact Name *

Organization Email *

Organization Phone *

Mission Statement *

Vision Statement *

Are you a 501(c)(3)? *

Are you a church? *

Are you ministry-based in the US? *

Articles of Incorporation *

Physician / Medical Advisor

Enter the physician's name, email, and phone. After your application is approved, we'll send them a secure link to complete their authorization with their license details and signature. They don't need to log in to do this.

First Name *

Last Name *

Email *

Phone *

I certify that the person I am adding is, to my knowledge, a licensed physician authorized to supervise medical mission work for our organization. I understand they will receive an email to confirm their authorization and provide their licensing details directly.

Review & Confirm

Full Legal Name of Applicant *

Organization Application

Personal Information

Organization Information

Physician / Medical Advisor

Review & Confirm

Check Your Email

After you verify:

Submitting Your Application