Short Term Mission Trip Application Form
LifeSource Apostello Missions
/ap-os-tel'-lo/ noun: to order (one) to go to a place appointed
Ministry Leader: Ryan Holm
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Email *
Please check the mission trip you will or wish to attend. Check all that apply. *
Personal Information
First Name *
Middle Name *
Last Name *
Street Address *
City, State, Zip *
Home Phone *
If no home phone, put NA.
Cell Phone *
Preferred Email  *
Date of Birth *
Gender *
Marital Status *
Spouse's Name (if applicable)
Occupation *
Employer *
If you are a student, please list school name and grade level.
Work Phone
Passport #  *
We will need a photo of your passport. Instructions are at the end of this form.
Date of Expiration *
Please make sure your passport is current expiration date of no sooner than 3 months before desired trip.
Shirt Size: Please input your shirt size for a Missions TShirt *
Emergency Contact Information
Full Name *
Street Address *
City, State, Zip *
Relationship to person on mission *
Medical Insurance Information
LifeSource insurance can only be used as a secondary insurance. Check your policy to make sure you have the correct coverage for overseas and international travel for the requested trip. We will need a photo of both sides of your insurance card. Instructions are at the end of this form. **Uganda Only: Please make sure you provide documentation no later than 2 weeks prior to the trip for Yellow Fever Vaccination and Malaria Pill.**
Insurance Company *
Phone Number *
City, State, Zip *
Group/Policy # *
Plan ID # *
Primary Physician *
Phone Number  *
Please list any medical conditions or medications you have or take that the mission leader needs to be aware of while on the trip. *
Additional Information
Have long have you attended LifeSource? *
If you do not attend, how did you hear about LifeSource and these missions?
Have you attended the Journey partnership class? *
Please give your brief testimony. *
Due to limited capacity of the areas in which we will be staying on these trips, a non-refundable* deposit is
required to save and guarantee your spot on the trip. The first people to get this deposit to Ryan Holm in cash or check (made out to LifeSource Community Church with the trip requested in the memo) will be reserved for the spot.
Ryan Holm will make sure the money gets to the church account for missions:
Mexico: 12 total Spots $75 deposit
Uganda: 15 total Spots $250 deposit
that will be placed toward your airfare
* If your deposit is received after the allotted spots for the trip are full, you will be placed on a waiting list in case someone is unable to go. If you are not able to attend this trip requested, your deposit will automatically be moved and a spot reserved for the next available trip. If you are unable to attend the next trip, you may opt to move the deposit to another mission opportunity or request a refund.
By signing below, you are agreeing to be a participants on the mission(s) checked above. This form will be used for emergency and informational purposes only. Once submitted, you will receive contact from the mission leader regarding all aspects of the mission you have selected. *
Type your full name. If you are a minor, please have your parent or legal guardian sign here.
If you are a minor, please have the person who will be responsible for you during the trip sign below.
Type full name.
Date *
Photos of your Passport Page & Insurance Card must be emailed to immediately. Please be sure the photos are clear and include both sides of your insurance card.
Don't forget to hit the submit button.
A copy of your responses will be emailed to the address you provided.
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