Missions Trip Application

Your Name:

First NameLast Name

Your Small Group/Company Leader's Name:

Phone Number:

Area CodePhone Number

Email:

example@example.com

Birthday:

Date

Classification:

Trip Choices:

Prioritize your trip choices. Many of the trips have limited space for participants.

1.

2.

3.

More Information:

Are you under a physician’s care or taking any medications that your team leader should know about? Do you have any allergies? If so please include below:

Emergency Contact's Full Legal Name:

Emergency Contact Relationship:

Emergency Contact Phone Number:

Area CodePhone Number

International Trips ONLY:

Do you have a passport?

If no, are you planning to apply for one before the end of the year (2023)?

Due to previous passport complications, we are asking that if you don't have one already, that you would start the process ASAP so that it will arrive in time for your trip.

Also, if your passport expires December 2024 or earlier, you will need to apply for a new one.

Issuing Country:

Passport Number:

Passport Expiration Month & Year:

Tell us in a brief statement why you would like to go on a missions trip:

Explain why you want to go to the location stated in your number one choice and why you listed it as number one:

Have you been on a mission trip with Chi Alpha before?

If your answer was Yes, what trip did you go on?

Are you fully vaccinated for Covid-19?

If not already vaccinated: would you be willing to get vaccinated?