Mission Experience Application Form

Please fill out and send to Harvest Evangelism with $50.00 (non-refundable) deposit.

You may fill out this form and submit it online, or you can download the mail-in form and send it in to our address:
 
Please note that if you fill out the application online, we still need your $50 deposit.  Online payment may be available in the future.


note: fields marked are required.

Name:

Age:

Address:

City, State:

Zip:

Phone number:

Email:

Are you a minor?

Parent's name:

Marital status: Never married Married Divorced

Spouse's name:

Church name:

Church pastor:

Other people from your church that are going on this mission, if any:

Special gifts/talents the Lord has given you that you'd like to use on this trip:

Have you been on a mission trip with Harvest Evangelism before?

To where?

When?

Have you been on a mission trip with another group before?

To where?

With whom?

 

Health problems or allergies, if any:

Doctor's name:

Phone number:

Insurance carrier:

Policy number:

Do you receive the Harvest Evangelism newsletter?

Do you want to receive the Harvest Evangelism newsletter?

How will you be traveling to our mission site?

If you are flying, please enter your airline, departure city, flight time, arrival time, and flight number in the space below.

Which mission dates will you be attending?

Please write a brief testimony:

Briefly explain why you want to go on this trip and what you hope to get out of it:

I have filled out this application with honesty and prayer.  I do not hold Harvest Evangelism, Inc. or any person associated therewith liable for any injury during any portion of this Mission Experience (or for that of any minor child).

I agree to the terms of the above statement.