Mission Trip Participation Form "*" indicates required fields Trip Destination*- Select one -Spain 2024Oklahoma 2024New York 2024Madagascar 2025Thailand 2025Honduras 2025OneLink 2025Crossover 2025Name (as it appears on your ID)* Date of Birth* MM slash DD slash YYYY Passport # Passport Country Expiration Date MM slash DD slash YYYY SWBTS ID* Are you a current student?- Select one -YesNoAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Preferred Email* PhoneCell PhoneLocal Church Is this church part of the SBC?- Select one -YesNoProvide name and number of a Pastor, missions leader, or spiritual mentor for reference Please list all allergies (food and medicinal)Emergency Contact (not on the trip) Relationship Emergency Contact PhoneEmergency Contact Email Please explain your mission/evangelism experienceConsent* I agree to the following policies. I will submit the non-refundable deposit designated for the specific trip (required to secure a spot on the team) to the WMC.I will read the WMC Mission Trip Handbook and adhere to the contents withinI will submit the Release and Hold Harmless Agreement form to the WMCI will submit the Medical Power of Attorney form to the WMCI will submit the Team Fund Agreement form to the WMC and agree to submit funds per the attached scheduleI will submit a copy of my passport to the WMCI will personally handle all requirements necessary to secure my travel visa, should I need one to go on this tripFor IMB affiliated trips, I will get a background checkFor IMB affiliated trips, I will watch the Child Protection Training videosI will inform the trip leader that I would like to enroll in course(s) affiliated with this mission tripI commit to support raising the total amount of funds for the tripI commit to participate in pre-trip preparation and all team meetings prior to departure, while on the trip, and after returningI commit to sharing my experience with my church upon my returnI confirm that I do not have any health issues that would prohibit me from participating in the rigors of all activities engaged in on this trip. I also affirm that if I reach the point where--for any reason--I may need or want to return home before the completion of the trip, I will bear any additional costs incurred by this decision Consent* I agree to the electronic signature policy.Submitting this form is your confirmation that the form you have filled out is your own work and the information is factually true. Once you submit, this will count as your electronic signature.Application not considered complete until $200-$300 deposit has been turned inNameThis field is for validation purposes and should be left unchanged. Δ
