Name:

Mailing address

City      State      Zip 

Daytime Phone Number 

Email address 

Travel dates 

Group name 

Sponsoring organization 
 

PERSONAL INFORMATION:

Spanish Language abilities
  none       a little       conversational       fluent

 Previous missions trip experience

Special skills or hobbies

Occupation

Marital status  
  Married       Single

I would like to room with
  My spouse   Someone else  (Their name is )

I am a
  Male            Female

My t-shirt size is
  Adult small   Adult medium     Adult large   Adult XL   Adult XXL

My Church Affiliation:

Church name 

Church Address 

City         State        Zip 

In case of emergency, contact:

Name 

Phone number 

Relationship 

I understand that teamwork and trust are essential to any successful mission experience. A commitment to participate in this project includes willingness to be a part of the team, to abide by the guidelines that any community requires, and to be a positive contributor to the spirit of the group. I am willing to serve in this spirit. I agree to refrain from any activities that are considered by our Christian hosts to be inappropriate in the missions field (alcohol, tobacco, swearing, going to discos, wearing revealing clothing, etc.).

  I agree to abide with the above statement.

  I do not agree to abide with the above statement.

Signed (type your name) 

Date