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DRMT Application 2017
INSTRUCTIONS: This application is required for every member of the 2017 DR Mission Teams. It is vital information needed to secure plane tickets, organize teams, and keep everyone healthy and safe while in the DR. This application and your non-refundable deposit of $100 are necessary to initially reserve your spot on the trip (please see http://drmissionteam.org/support for all of the payment options and details).

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Please fill out the form below and hit submit. By submitting this form, you are verifying that all information is accurate and correct.

Questions? Please email john@drmissionteam.org or call 203-626-2239.

First Name as it exactly appears on your passport
Your answer
Middle Name or initial as it exactly appears on your passport
Your answer
Last Name as it exactly appears on your passport
Your answer
Full Name as it exactly appears on your passport
If you are applying for your passport, please list here the name you will use on your passport. This has to be exactly as it will appear on your passport as it will be used with the airline for your ticket.
Your answer
Date of Birth
Your answer
Country of passport
Your answer
Passport expiration date
Your answer
Address
Your answer
Town
Your answer
State
Your answer
Zip Code
Your answer
Phone
Your answer
Email
Your answer
Gender
Required
T-shirt size
Required
Indicate your preferred week(s) in the DR:
Required
Church Affiliation (if applicable)
Your answer
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