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Mission Emanuel: 2023 Short-term Trip Registration Form
ALL individuals going on a trip with Mission Emanuel must complete this form.
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Email
*
Your email
Trip dates
*
Which group will you be joining for 2023?
6. The Christ School - Orlando, FL
7. Westminster Catawba Christian - Rock Hill, SC
8. FPC Lexington - Lexington, NC
9. Highland Park Presbyterian Church (Youth) - Dallas, TX
10. Orlando Fellows (Oct 4-7) - Orlando, FL
11. Fall Open Trip (Oct 14-20) - all cities
11a. Board Meeting (Oct 13-15) - Board Members only
12. River Oaks Community Church (Nov 11-17) - Clemmons, NC
13. Texas Families (Nov 17-22) - Austin, Houston, and Dallas, TX
Required
Trip Participant Information
Please complete this information for yourself and for each family member (if applicable).
First Name
*
Your answer
Goes By
Your answer
Last Name
*
Your answer
Gender
*
Male
Female
Required
Date of Birth
*
MM
/
DD
/
YYYY
T-shirt Size
*
Each participant receives a Mission Emanuel t-shirt included in the ground cost fee.
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
Youth Small
Youth Medium
Youth Large
Other:
Other Information
Is this your first international mission/service trip?
Yes
No
Clear selection
If you are a college student, what college/university do you attend?
Your answer
If you are in the workforce, what is your vocation/occupation/profession?
Your answer
What is the name of your church (if any)?
Your answer
Is this your first time to Mission Emanuel?
Yes
No
Clear selection
If not, how many times have you been to Mission Emanuel?
1
2
3 or more times
10 or more times
Clear selection
Do you (or parent, if under 18) give permission for Mission Emanuel to use your photo for promotional purposes?
*
Yes
No
Passport Information
If you do not currently have a passport or it is being renewed, please say "renewal" or "application in process" in the Passport Number and Expiration Date fields.
Passport Number
*
Your answer
Country of Residence
*
From which country did you receive your passport?
USA
Other:
Expiration Date
*
When does your passport expire? If your passport is due to expire within 6 months of your travel, you will need to renew your passport prior to the trip. (
https://travel.state.gov/content/travel/en/traveladvisories/ea/passport-covid-19.html
)
MM
/
DD
/
YYYY
Mailing Address
Where do you prefer to prefer to receive mail?
Street Number and Name
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Contact Information
Email Address
*
Please submit an email address that you check regularly
Your answer
Phone Number
*
Your answer
Preferred Method of Contact
Email
Phone
Emergency Contact Information
Who should we contact in the event of an emergency while you are traveling?
Emergency Contact Name
*
Please type the first and last name of your emergency contact person.
Your answer
Relationship to you
*
How do you know this person?
Spouse
Parent
Other relative
Co-worker
Friend
Other
Emergency Contact Phone
*
Please list a phone number where your emergency contact may be easily reached.
Your answer
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