First Name

Last Name

Email

Email Address

Sponsoring Organization

Phone Number

Contact Person

Contact's Phone or Email

Where do you plan to go on this trip?

On what date will you be leaving?

On what date will you return?

With whom will you be staying?

Which of the following will you be doing? (Check all that apply)
Evangelism
Teaching
Personal growth or exposure to missionary life
Providing help to an existing mission

Please provide descriptions of how you will fulfil all the roles you identified.

Are you a member at CBC
Yes
No

Please provide a brief statement regarding your personal testimony of salvation.

What is the total amount needed for your trip?