Name: *

First Name

Last Name

Address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone: *

(###)

###

####

Passport: Date of Issue *

MM

DD

YYYY

Passport: Expiration Date *

MM

DD

YYYY

Primary Policy Holder: *

First Name

Last Name

Policy Holder:

First Name

Last Name

I am able to engage in vigorous outdoor activities

Church Address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Church Phone Number: *

(###)

###

####

Church Contact Person:

First Name

Last Name

Musical Skills

Solo Singing

Group Singing

Music Leader

Children's Songs

Speaking Skills

Evangelism

Preaching

Youth

Children

Teaching Skills

Teaching Pastors

Teaching Men/Women

Teaching Youth

Teaching Children

Other Skills

Drama

Photography/Videography

Art/Poster/Graphic Design

Technical Computer Skills

First Aid

*

I am willing to work under the direction of missionaries and national pastors, to accept and to perform any and all assignments willingly.

*

I am willing to conform to the lifestyle standards of the local church leaders, even if these standards are stricter than my own.

*

I hereby acknowledge my financial obligation in raising the funds for my portion of the mission trip, and that failure to raise sufficient funds may disqualify me for participation in this mission trip.

*

I hereby certify that the above statements are true and correct to the best of my knowledge. I understand that a false statement may disqualify me for participation in this mission trip.