Short Term Mission Trip Application
World Renewal International P.O. Box 399 Greenfield, IN 46140
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After completing and submitting this form, you will:
1) Receive a confirmation email of your submission
2) Be contacted by a World Renewal representative to answer any questions you or your family may have
3) Be invited to participate in the Short-term Mission Trip Training Program
_______________________________________________________
Short Term Mission Trip Destination:
*
Bahamas
Hungary
Haiti
Jamaica
Brazil
Mexico City
Other
Have you traveled with World Renewal before?
*
Yes
No
Date of Application:
*
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Day
Year
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AM/PM Option
First Name:
*
Middle Initial:
Last Name:
*
Phone Number:
*
Cell Number:
Home Address:
*
Email Address:
Passport Number:
Date of Birth:
*
Please select a month
January
February
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Please select a day
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Please select a year
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Year
Sex:
*
Male
Female
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Marital Status:
*
Please Select
Single
Engaged
Married
Separated
Divorced
Widowed
Name of Spouse:
Children living at home (names and ages):
Children going on this trip:
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Church Affiliation
What church do you attend?
*
How often do you attend ?
*
Please Select
Regularly
Often
Seldom
Are you a member?
*
Please Select
Yes
No
Church's Address:
*
Church's Phone number:
*
Church's Denomination:
*
Church's Senior Pastor:
*
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Past Short Term Ministry Experience
Place or Group:
*
Purpose of Trip:
*
Dates of Trip:
*
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Next Steps
1: Sign this form (type your name in the required field. If you are under 18 years of age, your parent or legal guardian will need to sign this form as well.)
2: Send a Check for $100 as a deposit (make checks payable to World Renewal International at P.O. Box 399 Greenfield, IN 46140 or click on the paypal button below)
3: Click on the submit button.
Signature:
*
Parent or Guardian signature:
Submit
Should be Empty: