911 Life ITEC Application Form
This form is part of the application process for any of the training courses that are offered at the International Training and Equipping Center which is a ministry of 911 Life.

If the applicant has any questions they can contact us at info@911life.org.  

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PERSONAL INFORMATION
First Name *
Middle Name
Last Name *
Have you ever ministered with 911 Life or Tom and Jen Atwater in Medellin before? *
If you answered "yes", please explain in what capacity.  
Date of Birth *
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If the missions participant is a minor please write the father´s and mother´s names below with phone numbers and e-mail addresses.
Gender *
Cell Phone Number *
E-mail Address *
What is your profession? *
HEALTH & INSURANCE INFORMATION
Do you have any diagnosed physical or mental health conditions? *
If so, please explain:
Do you have allergies to food, medicine, etc.? *
If so, please describe.
Please list any condition: physical disability, mental or psychological diagnosis or issues, and or medication that may limit your participation during your time in Colombia.
HEALTH INSURANCE IS REQUIRED FOR YOUR TRIP.  Do you have primary medical insurance? *
If so, what is the name of your insurance provider and policy number?
Does this insurance cover cases that occur internationally?
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Do you have travel insurance that includes medical emergency coverage? *
If so, what is the name of the insurance provider and policy number.
If not, you will need to purchase travel insurance that includes medical emergency coverage before you arrive.  Please indicate below when you will send us the insurance company and policy number
Emergency Contact Name *
Emergency Contact Phone Number *
What is your relationship to the emergency contact? *
PASSPORT INFORMATION
Do you have a passport? *
What is your passport number? *
Country of issue *
When does your passport expire? *
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FAITH, CHURCH, & MINISTRY INFORMATION
Is Jesus your personal Lord and Savior? *
Have you ever had a personal encounter with the Holy Spirit? *
What's the name of your church, city and state. *
What's the name, phone number and email of your pastor. In case your pastor is not your spiritual, also include the name, number and email of your spiritual leader.
Do you serve in a specific ministry at a local church body in your area? *
If so, in what ministry/ministries do you serve  at this local church?
SUPPLEMENTAL INFORMATION
What made you interested in this trip? *
What are you most passionate about? *
Do you have experience with children? *
Have you received any Christian ministry training?  If so, please describe below. *
Do you have any specific talents/skills you would like to use on this ministry trip?   If so, please describe below. *
Do you speak Spanish? *
If so, what level?
Have you ever been convicted for any criminal offense? *
If so, please explain.
TEAM MEMBER INFORMATION AGREEMENT
Please read the text below. The check box consitutes as your legal digital signature.
I affirm that the information provided by me in this  form is true, correct and complete to the best of my knowledge. I authorize 911 LIfe  to verify any and all information provided. I understand that if  there are any false statements, omissions, or other misrepresentations made by me on this application, it may result in my immediate dismissal. *
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This form was created inside of 911Life.