Passport Information

Name as listed on passport::

First & Middle:                                                                 Last:

Passport Number:

Personal Information

Home Address

City:                                              State:                                Zip:

Email Address:

Home Phone:

Fax: Cell Phone or Beeper:

Date of Birth:                                                  Nickname:

Spouse’s Name:                                              Date of Marriage:

Children Names:

Employed By:                                                    Work Phone & Ext.:

Business Address:

Job Title:                                          Type of work you do:

Emergency Contact    (Some one not going on trip with you)

Name:

Address:

State:                                     Zip:______________  Phone:_____________________

 

Church Information

Church Name:

Church Address:

Church Phone:

Pastor Name:

Year of conversion:

Offices held in Church:

 

Mission Team Experience:

 

A word of personal testimony about your relationship to the Lord Jesus Christ:

 

 

 

 

Health Issues:

 

 

Circle the areas you have experience and/or you would like to work:

Carpentry                    Painter               Plumber               Sheetrock Hanger

Sheetrock Finisher    Electrical              Framing             Concrete Work

Roofing                       Brick/Block Mason                      Sound System

Mechanic                        Photography                      Kitchen Helper/Cook