Mission Trip Form

JMI Mission Trip Form

First Name (required)

Last Name (required)

Travel Contact # (required)

Mission Trip Location (required)

Hotel Name (required)

Whose Name is the Hotel Listed in:

Name(s) of Roommates

Mode of Transportation (required)

Other mode:

If by Train or Bus, which station?

If by Airplane, Which Airport?

NC Departure Date (required)

NC Departure Time (required)

Mission Trip Location Arrival Date

Mission Trip Arrival Time: (required)

Departure Date From Mission Trip Location

Departure Time From Mission Trip Location

NC Arrival Date: (required)

NC Arrival Time: (required)

IN CASE OF EMERGENCY /Please List someone who is not traveling with us (required)

Relationship (required)

Telephone Number/Cell Number (required)

I affirm that I participate voluntarily in the mission trip and thereby, assume all risks involved with such participation. Type Your Name in the box below.(required)