Mission Trip Interest Form

Name

Trip Dates you are interested in:

Address

Phone #

Cell #

Email

Emergency Contact Name

Emergency Contact Phone #

Emergency Contact Alternate #

Relationship To You

Home Church

Active/Regular Attendee?
YesNo

Degree/Specialty/Medical License (If Medical)

Do you have a valid passport?
YesNo

Exp Date

Have you ever participated in any other mission trips? (Domestic or abroad) When and where?

Please describe any special talents or abilities that you feel might be useful on this mission trip (examples might include but are not limited to special work experience, playing musical instruments, previous work with children or youth, etc.)

Do you speak Spanish fluently?
YesNo

If yes, could you serve as an interpreter?
YesNo