Africa Mission Travel Interest Form
Dr. Ty greatly appreciates your interest in joining her as she travels with a purpose. Please take a moment to complete this interest form so that Dr. Ty can gain insight into your preferences, requirements, and any limitations you may have concerning travel. Your input will help determine if this experience suits your needs and interests.
Full Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
-
Month
-
Day
Year
Date
Do you have a valid Passport?
** Travelers are required to be in possession of passports that are valid for six months beyond the period of their intended stay. **
*
Yes
No
Have you been abroad before?
*
Yes
No
Are you aware that this trip is primarily a Mission Trip in support of the Hendricks HOPE Foundation?
*
Yes
No
Would you be comfortable and willing to visit the children being supported in Africa?
*
Yes
No
Would you be willing to make a charitable contribution or encourage others to do so in support of the children or mission?
*
Yes
No
Do you have any physical or health restrictions that may hinder your ability to navigate uneven ground?
*
Yes
No
Will you be able to handle your own luggage without assistance?
*
Yes
No
Do you have any food/diet restrictions? (Religious, Allergies, On a diet, etc.) Check all options that apply:
Religious diet (Halal, kosher, etc.)
I have allergies
I have some form of stomach sensitivity.
I am on a diet
Other
Additional Information - Please write any travel conditions that need to be known before we travel.
If you have any questions, please put all inquiries about the trip here.
Please upload all necessary files.
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