Application

We have tried to make the application process easy for you, please fill out the fields as completely as possible. After your application is received a $50 application fee must be received (Fee in non-nonrefundable unless your application is rejected). See the bottom of the page for more information.

Which upcoming mission trip are you interested in and how did you learn about it?

Biographical Information


Complete Name (As Shown on Passport)

Address

City

State

Zip

Country

Home Phone

Cell Phone

Your Email (required)

Date of Birth

Sex
MaleFemale

Occupation

Foreign Languages

Place Of Birth

Citizenship

Passport Number

Passport Issued Date

Passport Expiration Date

Passport Issued At

Marital Status:
MarriedSingle

Shirt / Blouse Size:
SmallMediumLargeExtra Large




Previous Mission Information (locations and Dates):


#1

#2

#3


Home Church


Briefly, share how you came to know the Lord:


Every team member is requested to have at least two people praying for them while on your mission.

Please list two people that you will ask to pray for you:


#1


Name

Address

Phone


#2


Name

Address

Phone


Emergency Information

For emergency purposes please provide the name, address and phone number of a family member or friend:


Relationship


Name

Phone

Email

Address

Medical Information


Blood Type:


Height:

Weight:

Are you in good health ?
YesNo

When was your last complete physical examination?

Any physical handicaps ?
YesNo

If Yes please explain:

List any major illnesses you have had:


Do you have any communicable diseases ?
YesNo

If Yes please explain:

Are you presently on medication or under a physician’s care ?
YesNo

If Yes please explain:

Any Food Allergies or Concerns ?

YesNo

If Yes please explain:

Criminal History


Have you ever been convicted of or plead guilty to a serious crime ?
YesNo

If Yes please explain:

Anything Else you would like to tell use about ?


Legal Disclaimer
I hereby agree that I will not hold Global Outreach International nor any representative thereof, legally responsible for any accident, sickness, injury, dismemberment, death or loss of property while on the mission or in route to or from the mission field.


Signature (typed name):

Date:

Comments are closed, but trackbacks and pingbacks are open.