Armenia Mission Trip Application Form

Name:*

Gender:*

Phone Number:*

Address:*

Email:*

Birth Date:*

Marital Status:*

Name as it appears on passport:

Passport Number:

Passport Issue Date:

Passport Expiration Date:

Place of issue:

Are you using any recreational drugs or intoxicating substances without a doctor's prescription?*

If so, please explain:

Are you covered by personal or family medical insurance?*

How would you describe your present health?*

Please list any major illnesses or procedures in the past 5 years:*

Are you currently under the care of a physician?*

If yes, please explain:

Please list any medications you are currently taking:*

Please list any allergies you have:*

Please list any physical challenges you may face on this mission trip:*

Emergency Contact:*

Emergency Contact Phone:*

Are You a Member of Salem Baptist Church?*

If not, at which church are you a member?

If you are not a church member, where do you regularly attend?

How long have you been a member or regular attender?*

Have you been baptized?*

Are you an active member of a Bible Fellowship Group?*

If so, which one?

How often do you attend worship services?*

Please list the areas in which you are presently serving:*

Share your testimony. How did you come to know Jesus?*

What is the Gospel?*

Describe your current relationship with Jesus:*

In what ways have you seen spiritual growth in your life in the past year?*

List past mission trip experience including location(s) and year(s):*

Share a recent opportunity you had to share your faith with someone:*

Why do you feel the Lord leading you to go on this trip?*

What talents or skills do you have that would be beneficial for this trip?*

How do you hope the Lord will use this trip in your life?*

Do you know of anything that would hinder you from participating in this trip? If so, please explain:*