2019 Cambodia Mission Trip Sign Up
Sign-ups are closed as of 3/20!
Please only use this form if you have spoken with Ariana Lee about joining and still need to fill out the form.

Please sign up if you plan to join us on our annual Cambodia summer mission trip! Please only sign up if you have gotten parent's approval and confirmed that you can attend.

Trip Dates: Thurs 6/27 - Wed 7/10

Training Dates: Mon 6/24 - Wed 6/26

Estimated cost (before fundraising discount): $1230

Name *
(As we know you)
Your answer
FULL Name on Passport *
Please include your Middle Name if you have one
Your answer
Grade *
Date of Birth (needs to match passport) *
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DD
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YYYY
Email *
Your answer
Phone Number *
Your answer
Home Address *
Your answer
Name of Emergency Contact (Parent or Legal Guardian) *
Someone who will be in the United States
Your answer
Email of Emergency Contact (Parent or Legal Guardian) *
Your answer
Phone Number of Emergency Contact (Parent or Legal Guardian) *
Your answer
Do you have a written draft of a salvation testimony? *
Will you need a different itinerary?
E.g. flying to Korea straight from Cambodia at the end of our mission trip.
If you answered YES to the above, please specify dates and location of your flights.
E.g. Phnom Penh to Ichon Airport 7/10, Inchon to SFO 7/20
Your answer
Can we book your travel for you from Cambodia to your other destination? (Highly recommended)
You will need to pay the total amount including travel to Cambodia and the rest of your itinerary.
Any questions/comments?
Your answer
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