scope rental and usage Application

We desire to assist missionary doctors who are like-minded with a loaner scope for international mission endeavors to the under-served. For more information on the scope;  CLICK HERE. The first step to reserving the scope for your mission endeavor is to complete the following application.

Following is a brief questionnaire designed to help us help you. Your participation in this effort provides the groundwork for synergy, partnership, and effective communication. Please read the following information, check all that apply, and give us as many details as possible. Thank you!

Location to where we should ship the equipment
Name of Destination
Who is organizing this event "IN COUNTRY?"

By typing your FULL NAME and signing in the SIGNATURE BOX, you agree to the following:


I release Vision Outreach International (VOI) , its officers, trip organizers and leaders, members and team associates from responsibility for any accident, injury, sickness or death to me or any member of my mission team as a result of this mission and usage of this equipment. I understand and accept the personal health and safety risks involved.


I will be a guest of the host country and subject to the local laws and customs of their country and the host organization.


I understand that should it be necessary for me to cancel this agreement, any refunds will be subject to the discretion of Vision Outreach International.


I have read, understand and agree to the condition of this waiver, and do affirm that I am the person whose name appears below.


I realize that SIGNING my name in the SIGNATURE BOX affirms that I have filled out this application with valid and correct information and agree to abide by its contents.

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