Mission Assure
  • Is your trip affiliated with AG World Missions?*

  • Please register through AG World Missions at wideopenmissions.org.

  • Assumption of Risk and Parental Consent Forms

  • It is the responsibility of the applicant to accurately complete all required applications and forms and to ensure that they have been provided to the team coordinator for processing. Failure to do so will result in the prohibition of filing of any claims. AGFinancial Insurance will not be responsible or liable for any losses incurred by applicants failing to follow the prescribed procedures.

  • Before beginning the application, please upload all completed assumption of risk forms (adults ages 18 and up) and parental consent forms (minors below the age of 18) in their entirety for each team member.

    AGFinancial Insurance requires these forms from each team member in order for them to be eligible for coverage.

  • Upload a File
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  • Have all necessary forms been uploaded?*

  • Contact Information

  • Format: (000) 000-0000.
  • Are You the Travel Leader? *
  • Format: (000) 000-0000.

  • Trip Information

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  • END DATE MUST BE AFTER THE START DATE

  • Nature of Sponsored Mission Activity (Check All That Apply)*

  • Method(s) of Transportation During Trip (Check All That Apply)*

  • Is Any Part of Your Trip Outside the United States? *

  • Participant Information

  • Payment

  • How Would You Like to Pay

  • If paying by check, you will not receive your Mission Assure policy card until your check is received and processed. If your trip is within two weeks, please pay by credit card. 

     

    Please make your check payable to AGFinancial Insurance and mail to:

    AGFinancial Insurance
    ATTN: Mission Assure
    PO Box 10263 
    Springfield, MO 65808-0263

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    USD
    Credit Card

  • END DATE MUST BE AFTER THE START DATE

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