Church-Wide Short-Term Trip Application
We are so glad you want to come on a mission trip with us this summer! Please fill out the information below. If you have any questions, email gabe@antiochbr.com.

Trip Dates: June 28-July 7

Your Full Legal Name (as it appears on passport) *
Your answer
Your Birthday *
MM
/
DD
/
YYYY
Your Passport Number
Your answer
Your Passport Expiration Date
Your answer
Are you applying as a family? If so, list each members' full legal name, birthday, passport number and passport expiration date.
List each member on a new line. Ex. Jane Doe, 06/19/1999, 12345678, 03/22/2026.
Your answer
Your Email *
Your answer
Your Phone Number *
Your answer
Are you a part of a Lifegroup? If so, who is your leader? *
Your answer
How long have you been a part of Antioch? *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
What is your emergency contact's relation to you? *
(i.e. mom, dad, grandmother, etc.)
Your answer
Why do you want to come on this trip? *
(Please answer in 2-3 sentences)
Your answer
How do you feel about sharing your testimony/the Gospel and praying for people? *
(Please answer in 2-3 sentences)
Your answer
What would you like to learn before we leave? *
(Please answer in 2-3 sentences)
Your answer
What are you excited about for the trip? What are you nervous about? *
(Please answer in 2-3 sentences)
Your answer
Have you been on a short-term trip before? If so, please list.
Your answer
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