Mission Trip Application

Name*

First Last

Date of Birth*

Today's Date*

Are you a member of FBP?*

Yes
No

Which trip are you applying for?*

Address*

Street Address City State ZIP Code

Email*

Phone*

Emergency Contact Information

Emergency Contact*

First Last

Emergency Contact's Relationship to You*

Emergency Contact Phone*

Emergency Contact Email

Beneficiary Information

This is for travel insurance purposes only.

Beneficiary Name*

First Last

Beneficiary's Relationship to You*

Beneficiary Phone*

Beneficiary Email

International Travel Information

Please answer the following questions ONLY if you are applying for an international mission trip.

Are you a U.S. citizen?

Yes
No

Have you traveled internationally?

Yes
No

Do you have a passport?

Yes
No

Passport Number

Name EXACTLY as it appears on your passport

Passport Issue Date

Passport Expiration Date

Please upload a copy of your passport

Max. file size: 250 MB.

Airline Information

If applicable, please answer the following questions.

Airline Special Diet Requests?

Preferred Seating

Travel Insurance

FBP provides basic travel insurance for all mission trip participants. You will be provided with information about the coverage that is provided, along with additional information about the opportunity to purchase additional coverage.

Health/Medical Information

Do you have any health issues or physical conditions that may limit your physical activity?*

Yes
No

If yes, please explain.

Please list any medications you take regularly (prescription and/or non-prescription).

Do you have any special dietary needs?*

Yes
No

If yes, please explain.

Please list any allergies.

Do you require an epi-pen?*

Yes
No

If yes, do you carry the epi-pen with you?

Please let the team leader know where the pen is located in case of an emergency.

Medical Insurance

Do you have medical insurance?*

Yes
No

If you answered yes, please answer the following questions.

Policy Number

Group Number

Policy Holder's Name

Insurance Company Name

Insurance Company Address

Do you understand and agree that by giving a $100 non-refundable deposit to FBP towards the purchase of an airline ticket for a mission trip, you are claiming full responsibility of the purchase price of that ticket should you withdraw from the team for any reason? Tickets are considered non-refundable and non-transferable, and you will be responsible for any amount charged for cancellation. If the trip is cancelled by the field or church, any trip payments will be returned. Do you also agree to have the balance owed for the mission trip paid in full by the time of departure?*

Yes
No

Comments

This field is for validation purposes and should be left unchanged.