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I am applying for acceptance as a Global Mission Awareness ministry team member for:

Destination (City, Country)*

Dates of Trip*

First Choice of Departing City*

Second Choice of Departing City*

Name (exactly as it appears on your passport)*

First Last

Nickname*

Note: Nickname will appear on nametag

Gender*

Male
Female

Date of Birth*

Were you born in Cuba?

Yes
No

Occupation*

If A Medical Professional, Please Indicate Your Field

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Phone*

Secondary Phone

Email*

Link to Facebook Profile

Passport Number

Passport Expiration Date

Emergency Contact Name

First Last

Emergency Contact: Relationship

Emergency Contact: Phone

If Married, Does Your Spouse Support Your Participation?

Yes
No

Spouse's Name

Have You Previously Traveled With GMA?

Yes
No

If Yes, Give Dates...

Are You Willing To Minister Consistent With GMA's Guidelines

Yes
No

Are You Willing To Submit To Being Monitored and Lovingly Corrected If Necessary?

Yes
No

How Would You Describe Your Temperament?

Do You Have Any Physical Disability?

Yes
No

If "Yes", Please Explain...

Have You Ever Been Treated For A Mental / Emotional Condition?

Yes
No

If "Yes" Please Explain...

Please List Any Condition(s) That May Limit Your Participation:

Please List Any Medication, Allergies To Food, etc.

Medical Insurance Provider

Policy #

Church Name

Denomination

Church Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How Long Have You Attended?

Name of Pastor

First Last

Phone

Are You Born Again

Yes
No
Unsure

Are You Spirit-Filled

Yes
No
Unsure

Do You Tithe Regularly?

Yes
No

Do You Attend Church Regularly?

Yes
No

Have You Been Water Baptized?

Yes
No

Have You Been Baptized in the Holy Spirit?

Yes
No

In What Areas of Church Life Are You Currently Serving or Have Served in the Past?

What Do You Believe Are Your Spiritual Giftings?

Have You Received Ministry Training in the Area of Healing?

Yes
No

If So, Please Describe:

Have You Received Any Other Christian Ministry Training?

Yes
No

If So, Please Describe:

Are You Fluent in Any Other Languages Other Than English?

Yes
No

If So, Which Language(s):

Shirt Size*

Are you interested in attending the midweek, Tacloban, excursion?

Yes
No

*

I declare that the information provided is true, correct, and complete to the best of my knowledge. I authorize Global Mission Awareness to verify any and all information provided above.

Date

Trip Deposit*

Price: $300.00

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