Sea Mercy Captain Form

Sea Mercy Captain Submission Form

For those interested in being considered for either the Sea Mercy Captain program for the Floating Health Care Clinic, First Response Fleet (Caribbean or South Pacific), or the RISE program, please complete the below form to the best of your ability.

Your Name *

First, last, and middle

Spouses Name

If applicable.

Address *

Home mailing address

City *

State *

Zip *

Country *

Email Address *

Phone Number

Best number to reach you

Personal website or Facebook page

Captain Program Desired? *

Please select either FHCC, Disaster Response, RISE, or All.

Submit CV/Resume

Please provide us with your resume/CV detailing your experience and background.

Desired Region(s) *

Which South Pacific or Eastern Caribbean (CB) island nations are you willing to operate an FHCC in? Use "Cntl" key for multiple selections

Name of your Vessel *

Website of your vessel (charter/blog)

Any online information or links that can help showcase your vessel

Type of Vessel *

Monohull, Catamaran, or Trimaran

Year built *

What year was the vessel originally launched?

Vessel manufacturer *

i.e. Custom design, Lagoon, Sunreef, Leopard, etc.

Picture of vessel

Please attach a picture of your vessel, to send more pictures, email them to seamercyorg@gmail.com (include the name of the vessel). Files accepted (gif, jpg, png, bmp, eps, tif, pdf, doc, ppt). Max file size is 4 MB.

Vessel location *

Where is your vessel currently located (Country, City)?

Length of Vessel *

What best describes the length of your vessel in feet?

Number of berths available (not counting crew) *

How many volunteer staff will your vessel be able to carry?

Desired Length of Service *

To justify and facilitate the rotation of volunteers and supplies, we have an initial 4 consecutive weeks minimum service between "time off" breaks (you determine length of breaks), if you are available or willing to operate for longer consecutive periods, please specify.

Operational Lease/Charge to Sea Mercy *

What is the weekly operational assistance/charge that you are seeking from Sea Mercy in order to operate your vessel as a FHCC? When calculating this number, do not include the cost of fuel, food (for crew and volunteers), or license and fees while in island nation (these will be covered by Sea Mercy).

Additional information or questions?

Please use this text area to include any additional information or questions regarding the Sea Mercy Captain program.

2018 Programs

Help us develop healthy, self-sustaining, and thriving communities across the South Pacific.
Click here to learn more about the RISE Program, Floating Health Care Clinic, the Amatasi Project, or to make a donation to support these programs through the below button.

Volunteer Registration

Volunteering has never been this much fun or rewarding! Use the below Volunteer button to start your incredible adventure in 2018.

Partners & Champions

We would like to recognize the following donors for their financial support of Sea Mercy:

Our Champions

Rick & Teri-Jo Rogge
Dr. Royce & Loriana Fonken
Tony & Brigid Whitton (Rosie Holidays)
Jonathan & Donna Robinson (s/v Chez Nous)
Staffan & Ellinor Ehde (s/v Salsa)
Courage & Shannon Winter (s/v Lil Explorers)
Stan & Valerie Creighton (s/v Buffalo Nickel)
Brian & Susan (s/v Darramy)
Lewis & Louise Hackett
Steve & Jenny Williams
Mike & Meredith Holguin
Al & Jill Wiggonton (s/v Dragonfly)
Suzanne Benloucif-Moore
Kim Parrish
Van Huynh
Dr. Peyton & Leslie Neatrour
Dr. Scott & Sarah Levison (DMD)
Grace Setiawan (DMD)
Dave & Lori Smith
Dr. Brian & Maryann Taylor
Dr. Clayborn Morris
Teresa Miller
Warren Family Dental (Madison, Wisconsin)

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