Service Request Form
Please fill out this form to start the service request process. Please note that you will need to fill out the form completely before it can be submitted. If you do not have all the information right now, you can click "save" at the bottom of the form and come back to finish it at a later time.
Requesting Organisation
Please choose requesting organisation
*
Please Select
Ballinacrow Church
Banbridge Church
Belfast Church
Blanchardstown Company
Coleraine Church
Cork Church
Derry / Londonderry Company
Drogheda Company
Dublin Drumcondra Company
Dublin Ranelagh Church
Dublin Romanian Church
Dublin West Church
Enniscorthy Company
Galway Church
Gorey Company
Kilkenny Company
Larne Church
Letterkenny Company
Limerick Group
Londonderry / Derry Company
Longford Church
Newmarket-on-Fergus Church
Portlaoise Company
Roscommon Company
Sligo Group
Tralee Company
Waterford Company
President / Secretariat (Irish Mission)
Departmental Sponsor (Irish Mission)
Individual
Other
Sponsor's Name
*
First Name
Last Name
Which Irish Mission Ministry / Department?
*
E.g. Youth Ministry, Children's Ministry etc
If you selected "Individual" or "Other", please give further details of requesting entity/person
*
Date Voted by Church Board
*
-
Day
-
Month
Year
E.g., by church board, OffCom, Pastoral Team etc.
We accept responsibility for ensuring that adequate Travel Insurance cover is in place, with appropriate levels of cover for hospitalisation & repatriation.
*
Please Select
Yes
No
If 'no' is ticked, the service request form may be delayed or rejected. Insurance can be obtained through Adventist Risk Management.
Person Requested or Invited
Name
*
First Name
Last Name
Email
*
Phone/Mobile Number
*
including international dialling code e.g., +44 7456 123 123
Status
*
Please Select
Denominational Employee
Lay Person
Retired Worker
Employing Organisation
*
E.g., South England Conference, Trans-European Division, South Norweigan Conference, Stanborough Press. You will need to ask the person for this information.
Address (if lay person/retiree)
*
Church where membership held (if lay person/retiree)
*
Full name of the church, e.g., Broadhust Central Seventh-day Adventist Church
Pastor's Name
*
First Name
Last Name
Pastor's Email Address
*
Pastor's Phone Number
*
including international dialling code e.g. +1 818 724 630
Assignment Details
Start Date of Assignment (including travel dates)
*
/
Day
/
Month
Year
Finish Date of Assignment (including travel dates)
*
/
Day
/
Month
Year
Purpose of Assignment
*
Brief description of why the person is being invited. What will they do?
Place of Assignment
*
Name of place & address
Responsbility for Expenses
Which entity is responsible for travel costs?
*
Please Select
Requesting Organisation
Other
To/From the Assignment
If you selected "Other", please state who will be responsible for travel costs and whom this has been agreed with.
*
Which entity is responsible for lodging costs?
*
Please Select
Requesting Organisation
Other
Accommodation
If you selected "Other", please state who will be responsible for lodging costs and whom this has been agreed with.
*
Which entity is responsible for board costs?
*
Please Select
Requesting Organisation
Other
Food, travel in situ, etc
If you selected "Other", please state who will be responsible for boarding costs and whom this has been agreed with.
*
Which entity is responsible for insurance costs?
*
Please Select
Requesting Organisation
Other
If you selected "Other", please state who will be responsible for insurance costs and whom this has been agreed with.
*
Details of Person who is Completing this Form
Name
*
First Name
Last Name
Email
*
Save
Submit
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