Mission Application Mission Application Mission Application Legal Name * First Name Last Name Date of birth * MM DD YYYY Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * (###) ### #### Gender * Male Female Passport # * Passport Exp Date * MM DD YYYY Marital Status * Married Single Employment Status * Employed Unemployed Retired Current Health Status * Excellent Good Not Good Are you on any special kind of diet? * Yes No Have you ever undergone psychiatric treatment? * Yes No I ACKNOWLEDGE ALL TRIP PARTICIPANTS WILL BE ASKED FURTHER MEDICAL INFORMATION ON A MEDICAL/LIABILITY RELEASE FORM, WHICH MUST BE COMPLETED AND RETURNED TO THE TEAM LEADER THIRTY DAYS PRIOR TO DEPARTURE, AS PART OF THE REQUIREMENT FOR TRIP PARTICIPATION.* * Yes No Are you a Christian? * Yes No How long have you been a follower of Christ? Church Name * Pastor's Name * Pastor's Email * In a few sentences, tell what Jesus means to you. * What is your reason for going on this specific trip? * I acknowledge that my signature(s) below is a commitment to going on the specific trip I specify. I acknowledge that no money submitted is refundable. All funds are designated to the trip, not an individual. I understand that my application does not guarantee my spot on the team. Gateway Missions strives to build diverse teams of new Gateway Missions team members along with veterans and has final discretion. * MM DD YYYY Thank you for your submission! We will get back to you shortly!
