Appalachia Mission Trip Registration

Appalachia Mission Trip Registration
Team Name *
Church / School / Other
Mailing Address - Please indicate if you have a PO Box. *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Main Contact Name *

First Name Last Name
E-mail *
Phone Number *
Will the above Contact also be the Group Leader? *

YES NO
If NO, please give the information for the Group Leader below.

First Name Last Name
E-mail
Phone Number
The following section is for teams with more than one Group Leader. Please give us the name and email address for any additional people you would like to add as a Group Leader and have access to Mission Trip Information. Please mark them as "Traveling" or "Not Traveling."

Ex. Church Finance Directors or Missions Pastors not traveling wiht the team but needing to know mission trip details.
Group Leader #2 Name

First Name Last Name
Group Leader #2 Email
Will Group Leader #2 be traveling with the team? Check all that apply.

Traveling with the Team and needs Mission Trip Information Not Traveling with the Team but needs Mission Trip Information Traveling with the Team and in charge of the Mission Trip Finances Not Traveling with the Team but in charge of the Mission Trip Finances
Preferred Trip Dates *
Minimum is 6 days
Arrival Day *

Month Day Year
Departure Day *

Month Day Year
Minimum is 6 days, travel days included.
Estimated Group Size *
Minimum is 4 participants.
Appalachia Mission Trip Options and Upgrades
Lodging *
*Please let your consultant know if you'd like to purchase additional rooms for your team.
Insurance *
Insurance Information can be found on our website.
Recreation Options

Please let us know below if you have already decided on recreation for your mission trip.
Please choose options that you'd like to add to your mission trip at this time.

Natural Bridge State Park and/or Red River Gorge Driving Tour - Breathitt/Wolfe County & Vicinity Mission Trips (Complimentary) Natural Bridge State Park Skylift ($20/person) Kentucky Reptile Zoo - Breathitt/Wolf County & Vicinity Mission Trips ($20/person) Kingdom Come State Park or Bad Branch Falls - Harlan/Letcher County & Vicinity Trips (Complimentary) Black Bear Citing - Driving Tour Portal 31 Mine Tour ($25/person) Kentucky Coal Museum ($15/person) Kentucky Splash Waterpark ($15/person) - Knox/Laurel/Whitley County & Vicinity Mission Trips Cumberland Falls State Park - Knox/Laurel/Whitley County & Vicinity Mission Trips (Complimentary) Kentucky Native American Heritage Museum - Knox/Laurel/Whitley County & Vicinity Mission Trips (Complimentary) Undecided at this time
For Groups Returning to Appalachia

If you are interested in serving with your previous church or ministry partner, please let us know!
Partner Church/Ministry Name and Location
Partner Church Pastor's Name
Requested Thirst Missions Staff
(Staff Requests are Subject to Availability)
Promo Code (optional)

Payment *

Group Registration Fee

$ 499.00

Total

$ 0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Appalachia Mission Trip Registration

Appalachia Mission Trip Options and Upgrades

Recreation Options

For Groups Returning to Appalachia