Malawi Partner Visit April 4-16, 2027

Malawi Partner Visit April 4-16, 2027
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Congregation Name and City
Dietary Restrictions
Diet/Allergy details
Blood Type (if known)
Medical conditions to note
List medications taken regularly with reasons
List fridge-stored medication
Overall physical health (1-Poor, 5-Very Good)

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5

1 is Worst, 5 is Best
10000 Steps count frequency (1-Never, 5-Daily)

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5

1 is Worst, 5 is Best
Mobility on uneven surfaces (1-Need assistance. 5-No Problem)

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5

1 is Worst, 5 is Best
Long bumpy rides tolerance (1-Dislike, 5-No Problem)

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5

1 is Worst, 5 is Best
Car sickness susceptibility (1-Happens frequently, 5-No Problem)

1

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5

1 is Worst, 5 is Best
High altitude tolerance (1-An issue, 5-No Problem)

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5

1 is Worst, 5 is Best
Early mornings (1-Dislike, 5-Early riser)

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1 is Worst, 5 is Best
Late nights (1-Dislike, 5-Night owl)

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1 is Worst, 5 is Best
Early mornings & late nights (1-Dislike, 5-No problem)

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5

1 is Worst, 5 is Best
Unfamiliar food (1-Picky eater, 5-Adventurous)

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5

1 is Worst, 5 is Best
Reason for participating in this trip?
How will this contribute to your personal & professional development?
Describe previous cross-culture experiences
Other Comments
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