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 *
Trip dates *
Which group will you be joining for 2023?
Trip Participant Information
Please complete this information for yourself and for each family member (if applicable).
First Name *
Goes By
Last Name *
Gender *
Date of Birth *
T-shirt Size *
Each participant receives a Mission Emanuel t-shirt included in the ground cost fee.
Other Information
Is this your first international mission/service trip?
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If you are a college student, what college/university do you attend?
If you are in the workforce, what is your vocation/occupation/profession?
What is the name of your church (if any)?
Is this your first time to Mission Emanuel?
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If not, how many times have you been to Mission Emanuel?
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Do you (or parent, if under 18) give permission for Mission Emanuel to use your photo for promotional purposes? *
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 *
Country of Residence *
From which country did you receive your passport?
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)
Mailing Address
Where do you prefer to prefer to receive mail?
Street Number and Name *
City *
State *
Zip Code *
Contact Information
Email Address *
Please submit an email address that you check regularly
Phone Number *
Preferred Method of Contact
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.
Relationship to you *
How do you know this person?
Emergency Contact Phone *
Please list a phone number where your emergency contact may be easily reached.
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