CrossRoads Missions' Trip Registration & Deposit Form

1

Please tell us on which CrossRoads Missions field your team will be participating.* This field is required.

Appalachia

New Orleans

Mexico

2

Field Notification Recipient Email

example@example.com

3

Thank you for choosing to serve on CrossRoads Missions' {Field} field!

The total cost of your trip will depend on the total number of participants and the length of stay. Payment for your trip will be broken down as follows:

1.) Registration Fee - A registration fee of $500 is required in order to register your trip and reserve your selected dates.

2.) Trip Deposit - A non-refundable trip deposit of $100 per participant is due no later than 90 days prior to your team's arrival date.

3.) Final Trip Payment - Payment in full of the remaining balance of the cost of your trip is due no later than 30 days prior to your team's arrival date.

4

Which of the following would you like our help with today?* This field is required.

I would like to register our trip.

I would like to pay the non-refundable trip deposit of $100 per participant

I would like to make our final trip payment

My payment is for something else.

5

Initial Deposit Calculation - App & NOLA

6

Appalachia & NOLA Registration Placeholder

7

A registration fee of ${Registration} is required in order to register your {Field} trip and reserve your selected trip dates. This fee will be credited toward your final Trip Payment. Would you like to pay your deposit and register your trip now?* This field is required.

YESNO

8

Has your $500 registration fee already been paid?* This field is required.

Yes

No

9

Has your initial trip deposit of $100 per participant already been paid?* This field is required.

Yes

No

10

Final Trip Payment Calculation - App & NOLA

11

Would you like to register your trip and make this payment now?* This field is required.

Yes

No

12

Thank you for choosing to serve on our Mexico field!

The total cost of your trip will depend on the total number of participants and the length of stay. Payment for your trip will be broken down as follows:

1.)Trip Deposit - A non-refundable deposit of $50 per participant is required in order to register your trip and reserve your chosen dates. The deposit is due immediately upon registration and is non-refundable.

2.)Trip Payment - The amount of your final payment is the total trip cost less the deposit and initial payments. Your final payment is due no later than 90 days from your team's arrival date.

13

Which of the following payments are you making today?* This field is required.

I would like to pay my trip deposit.

I would like to make my final trip payment

My payment is for something else.

14

Please list the total number of Mexico trip participants including leaders* This field is required.The maximum number of trip participants is 80

Total number of trip participants

15

Additional Participant's deposit not paid placeholder placeholder for number to be used in calculation of final payment when additional participants have been added to the trip.

16

Mexico Trip Deposit PlaceholderRetains deposit calculation for future use within the form.

17

A trip deposit in the amount of ${DepositMex} is required to register your trip and reserve your selected trip dates. Would you like to pay your deposit and register your trip now?* This field is required.

YESNO

18

Mexico Trip Payment PlaceholderPlaceholder for final trip payment calculation to be used later in the form.

19

Has your trip deposit already been paid?* This field is required.

Yes

No

20

Church or Organization Name* This field is required.

Name of the Church or Organization your group is associated with.

21

Trip Leader's Name* This field is required.

First Name

Last Name

22

Please provide us with your full name* This field is required.

First Name

Last Name

23

Trip Leader's Phone Number* This field is required.

Please enter a valid phone number.

24

Please provide your phone number* This field is required.

Please enter a valid phone number.

25

Trip Leader's Email Address* This field is required.

example@example.com

26

Please provide us with your email address* This field is required.

example@example.com

27

Please select the length of your Mexico mission trip.* This field is required.

Regular Trip (Saturday - Friday)

5-Nights

4-Nights

3-Nights

2-Nights

28

Please select the length of your Appalachia mission trip* This field is required.

Regular Trip (Sunday - Saturday)

5-Nights

4-Nights

3-Nights

2-Nights

29

Please select the length of your New Orleans mission trip* This field is required.

Regular Trip (Sunday - Saturday)

5-Nights

30

Please indicate on which Saturday your Mexico trip is schedule to begin.* This field is required.

Date

31

Please indicate on which Sunday you'd like your {Field} trip to begin.* This field is required.

32

Please list the total number of trip participants including leaders* This field is required.The maximum number of trip participants is 50

Total number of trip participants

33

Has the total number of trip participants changed since your initial payment was made?* This field is required.

Yes

No

34

Transportation is available from the airport to Piedra Angular and back at an additional price of $75 per participant. Will your team need transportation?* This field is required.

YesNo

35

Please tell us how many participants your team has added or removed.* This field is required.Please use a negative number when indicating a decrease in participants.

36

Change in number of participantsThis is a placeholder for calculation purposes.

37

What Payment PlaceholderInformation to be transferred to other forms.

38

Terms and Conditions* This field is required.

39

Please tell us what your payment is for.* This field is required.

40

How much is your payment for {pleaseTell}?* This field is required.

41

Would you like to make this payment for {pleaseTell} now?* This field is required.

Yes

No

42

Which Payment Is Being MadeThis page is only to capture the answer to the question regarding the specific payment being made to allow the information to be used later in the form and in the credit card form

43

Trip Start Date* This field is required.

44

Total Amount Due* This field is required.

45

Credit Card Service Charge and Transaction Fee Calculation Placeholder.If the Credit Card Option is selected this form calculates the 2.9% service change + the .30 transaction fee to be added to the total amount due.

46

Total Amount Due + Service Charge PlaceholderTotal Amount Due with Service Charge

47

The total amount due is ${totalAmountDue}. How would you like to make your payment?* This field is required.

Credit Card

Paypal

Check

48

A credit card service fee of ${ServiceCharge} will be added to your total. Would you like to proceed with payment using your credit card?

YESNO

49

Thank you for registering your mission trip to our {Field} field.

When making your CrossRoads Missions trip payment by check, please follow ther guidelines below:

Checks should be made out to CrossRoads Missions.
The following information should be included on your check:

Check Number
Church/Group Name
The name of the CrossRoads field on which your team will be participating should be written on the memo line.

Checks should be mailed to the following address:

CrossRoads Missions
c/o Tim Anderson
3231 Ruckriegel Pkwy
Suite 111
Louisville, KY 40299

We look forward to serving with you in {Field}!