Mission Trip Group Application

 Application Date:___________________ 

Arrival Date:_______________________

Departure Date: ____________________

Church Name: _________________________________________________________________

Address:______________________________________________________________________

City:______________________________            State:_________  Zip code:_____________

Phone Number: (       )______________________

E-MAIL Address: _________________________

Group Contact Person:       

Name________________________________________________

Address ______________________________________________

City ___________________State ______Zip Code____________

Phone Number: (        )______________________________

E-MAIL Address: _________________________________

 Number of Participants:________________

 Travel Mode:              �   Flying          �  Driving

 Group type:                � Adults            �  Teens            �  Family          �   Mixed age groups

 Our Non-refundable deposit of __________________ is enclosed.

I have read the camp rules and guidelines and agree to the provisions therein.

Applicant�s signature:______________________________________