E. St. Louis Trip Registration Form 2019

  
First Name*
Last Name*
Mobile phone number (where we can reach you while on the trip)*
Email address*
Congregation
I have been on a mission trip before
 Yes
 No
I have a medical condition that others should be aware of.
 No
 Yes. I will let the coordinator from my congregation and/or my roommate know.
Emergency contact name*
Emergency contact home phone number*
Emergency contact mobile phone number*
Emergency contact relationship to you*
My skill level in Carpentry is
 No experience
 Can do with direction
 Can work independently
 Can lead others
 I am a professional
My skill level in Painting is
 No experience
 Can do with direction
 Can work independently
 Can lead others
 I am a professional
My skill level in Drywalling is
 No experience
 Can do with direction
 Can work independently
 Can lead others
 I am a professional
My skill level in roofing is
 No experience
 Can do with direction
 Can work independently
 Can lead others
 I am a professional
My skill level in Electrical is
 No experience
 Can do with direction
 Can work independently
 Can lead others
 I am a professional
My skill level in Plumbing is
 No experience
 Can do with direction
 Can work independently
 Can lead others
 I am a professional
My skill level in Landscaping is
 No experience
 Can do with direction
 Can work independently
 Can lead others
 I am a professional
Other skills I have include:
I am interested in helping to document the trip (photography, writing, filming, etc.)
 Yes
 No
I would feel comfortable leading a team of volunteers from different congregations
 Yes
 No
I plan to room with
 A family member
 A specific person on the trip
 I will need you to assign me a roommate
 I would like a room to myself at the additional cost of $200.
If you plan to room with someone specific, please provide his/her name
Any special needs for lodging or meals?
Please reserve a place for me for the Saturday excursion (at an additional cost).
 Yes, please.
 No, thank you.
Please order a photo book for me. Books cost $15 and will be available towards the end of 2019.
 Yes, please.
 No, thank you.


Submit

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