HCM Mission Trip Application
Please read the HCM Team Handbook thoroughly (www.haitianchristianmission.org/get-involved/take-a-trip/) and complete this form in its entirety. If you have any questions, contact your team leader or email us at trips@haitianchristianmission.org.

Thank you for partnering with HCM and we look forward to seeing you in Haiti very soon!

God bless!

Last Name: *
Your answer
First and Middle Names: (As they appear on your passport) *
Your answer
What do you prefer to be called?
Your answer
I would like to receive the monthly newsletter
Trip Dates: *
Your answer
Team Name: *
Your answer
Team Leader: *
Your answer
Church Affiliation and Pastor: *
Your answer
Home Address: *
Your answer
City, State, Zip: *
Your answer
Phone Number: *
Your answer
Email: *
Your answer
Birthdate: *
MM
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DD
/
YYYY
Gender: *
Airport you will depart from: *
Your answer
Passport #: *
Your answer
Expiration Date: *
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DD
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YYYY
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