SE MN Honduras Mission trip application 8/8-15/2020
Email address *
Passport Number (ex. 123123123): *
Your answer
Passport Exp. Date (mm/dd/yyyy): *
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DD
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YYYY
First Name as appears on passport: *
Your answer
Middle Name as appears on passport: *
Your answer
Last Name as appears on passport: *
Your answer
Nickname or name to be listed on your badge:
Your answer
Status/Position at time of trip *
Birthdate (mm/dd/yyyy): *
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DD
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YYYY
Gender *
Home Street Address *
Your answer
Home Street Address 2 (ex. Apt 5C, Ste 5, Bldg #3):
Your answer
City *
Your answer
Home State (2 letter abbreviation - ex. TX for Texas): *
Your answer
Home Zip: *
Your answer
Cellular Phone Number (If no cell phone number, indicate with NONE): *
Your answer
Email Address: *
Your answer
Home Phone Number:
Your answer
Name of your church: *
Name of your pastor: *
Your answer
Email Address of your pastor: (or unknown) *
Your answer
Are you willing to give a 5-10 minute devotional? *
Are you willing to lead praise & worship? *
Cross cultural experience? If so, please describe, or reply NONE: *
Your answer
Languages other than English? Please list and state proficiency.:
Your answer
List special skills you could contribute:
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Select shirt TYPE & SIZE below. (Unisex tshirt): *
Emergency Contact Name: *
Your answer
Emergency Contact Relationship to Applicant: *
Your answer
Emergency Contact Home Phone Number: *
Your answer
Emergency Contact Alternate Phone Number:
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List the best method to contact you (phone number or email address): *
Preferred time to contact you?
Your answer
Roommate preference?
Your answer
Dietary Restrictions?
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Do you have any medical conditions or disabilities that could limit your activities/or prevent you (and others) from safely performing the volunteer services for which you are applying?If yes, please explain:
Your answer
If currently taking medications, please list: (or NONE) *
Your answer
Known allergies: *
Your answer
What questions do you have for us?
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Deposit of $150 will hold your position on team :
(refundable until April 10th, 2020 when airline tickets are purchased) No cancellations after April 10th.
$575 due each on April 10th, May 10th, June 10th, Balance must be paid in full by June 10th.
Passport information (Name, #s, BDs, issue & exp dates) MUST be received by June 10th.
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