SIMPLY MISSIONS - Online Participant Application

Simply Missions on Facebook

A Division of

Member of

	Destinations
	Gulf Coast, Mississippi Denver, Colorado Guatemala Jamaica - Whitehouse Jamaica - CCCD Kenya Dominican Republic Spain Pretoria, South Africa

Application Form

Trip you are applying for:

About Me
First Name:
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Last Name:
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E-Mail Address:
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Parent's E-Mail (if under 18)
Address:
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City:
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State:
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Zip Code:
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Phone:
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Age:
Birthdate (MM/DD/YYYY):
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Single
Married
Occupation:
Current Grade Level (if in school)

Travel Documentation
Passport Status: check only one

Full Name as seen on Passport:
Passport Number:
Country Issued by:
Languages Spoken:

About My Church
Home Church:
Address:
City:
State:
Zip:
Phone:
Pastor's Name:

Title

Health
By submitting this application I certify that I am in good health.

Allergies:
Are you presently under a physician's care?

If yes please explain:
List Current Medications:

Emergency Contact
Relationship:
*
Name:
*
Address:
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City:
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State:
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Zip:
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Primary Phone:
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Alternate Phone:
Physician's Name:
Physician's Phone
Insurance Company:
Policy Number:

Gifts and Experience
Mention skills in a trade vocation hobby or profession in Christian ministry Bible study music childcare etc.
Please mention short or long term mission programs in which you have participated in the past:
List your travels abroad apart from mission-related programs:

Christian Testimony
Please describe your relationship to Jesus Christ:
*

Purpose
Please briefly state why you are applying to participate in this program:
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Your Prayer Partners
Prayer Partner E-Mail #1:
*
Prayer Partner E-Mail #2:
Prayer Partner E-Mail #3:

Mailing list signup:

Check this box to signup for our site mailing list.
Commitment & Deposit Info
TEAM MEMBER COMMITMENT: I commit to be a member of this team. I will submit necessary documents in a timely manner. I will participate in all team activities including required meetings and fundraisers. I will pray regularly for the team members. And I will be flexible. I hereby recognize that by failing to fulfill this commitment I will be subject to removal from the team.
Reservation deposit policy: A $150 reservation deposit is required at application and applies toward total program cost. 50% of the reservation deposit is refundable if requested by application deadline date. No refunds after application deadline date.

I agree to the Team Member Commitment.
Security code:
*
Do not enter anything in this field:

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