Standard Staff Employee TMK/Membership - Enroll

Please fill out the form below for your to secure your membership!

Congratulations! You are just a few steps away from becoming a GMAP telemedicine member. After you have completed this form and submitted payment, you will be contacted by VIGILINT staff to scheudule your appointment with a staff physician.

GMAP ANNUAL MEMBER PACKAGES

Please plan ahead! Travel Medical Kits will be shipped within 7-10 business days after your initial intake.

Email Address of Primary Member*

Primary Member Name *

Primary Member DOB *

Primary Member Country *

Primary Member Street Address*

Primary Member City *

Primary Member State*

Primary Member Postal Code*

Primary Member Phone Number *

Secondary Member Name (if purchasing a couple membership) (optional)

Secondary Member DOB (optional)

Choose an amount

Subtotal $1,218.00

Total Amount: $1,218.00

ACCEPT TERMS: By checking the box, you agree to VIGILINT’s TERMS OF SERVICES AND PRIVACY POLICY

*Aeromedical Evacuation: Adults over 75 years of age are required to submit a medical note and subject to additional charges

VIGILINT Staff Employee

Please fill out the form below for your to secure your membership!

GMAP ANNUAL MEMBER PACKAGES