Group Mission Trip Registration Form:
General Church Information
Church Name: __________________________________________
Church Address: ________________________________________
City: ____________________________State: _______ Zip: _____
Country: ______________
Church Denomination: ___________________________________
Group Leader: __________________________________________
Home Phone: _______________ Work/Cell Phone: ____________
Email: ___________________________
Senior Pastor/Missions Pastor's Name:
_____________________________________________________
Contact Information
(During travel days and while on outreach)
Emergency Contact Information
Emergency Contact Person: ______________________________
Home Phone: _______________ Work/Cell Phone: ____________
Email: ___________________________
General Group Information
Mission Trip Date Preferences: __________________________
What is the expected size of your group? ___________________
What is the age range of participants? ______________________
How many leaders or chaperons do you plan to bring with your group?
____________________________________________
Does your group have any Spanish speakers? _______________
Does your group have any special talents or abilities that may be utilized during ministry?
_______________________________________________________
_______________________________________________________
_______________________________________________________
Will you have any problem with doing physical labor or walking up to two miles per day during outreach?
_______________________________________________________
_______________________________________________________
How did you hear about ESMI?
Friend
Name of Friend (optional): _______________________
Conference Booth
Internet Search
Another Website
Name of Website: ___________________________________
Other
Describe:__________________________________________
__________________________________________________
Your Name: ___________________________________________
_______________________________________________________
Signature of Group Leader
Submit your form to:
Outreach Mission Staff
The Lighthouse
San Ignacio, Baja Calif. Sur. 23930 Mexico
Mailing Address:
ESMI
PO BOX 28111
Santa Ana, CA 92799 USA
Phone from US: 714-881-1065
Phone from Mexico: 615-154-0223
On the web at: www.esmi-mx.org
Email: missions@esmi-mx.org
General Church Information
Church Name: __________________________________________
Church Address: ________________________________________
City: ____________________________State: _______ Zip: _____
Country: ______________
Church Denomination: ___________________________________
Group Leader: __________________________________________
Home Phone: _______________ Work/Cell Phone: ____________
Email: ___________________________
Senior Pastor/Missions Pastor's Name:
_____________________________________________________
Contact Information
(During travel days and while on outreach)
Emergency Contact Information
Emergency Contact Person: ______________________________
Home Phone: _______________ Work/Cell Phone: ____________
Email: ___________________________
General Group Information
Mission Trip Date Preferences: __________________________
What is the expected size of your group? ___________________
What is the age range of participants? ______________________
How many leaders or chaperons do you plan to bring with your group?
____________________________________________
Does your group have any Spanish speakers? _______________
Does your group have any special talents or abilities that may be utilized during ministry?
_______________________________________________________
_______________________________________________________
_______________________________________________________
Will you have any problem with doing physical labor or walking up to two miles per day during outreach?
_______________________________________________________
_______________________________________________________
How did you hear about ESMI?
Friend
Name of Friend (optional): _______________________
Conference Booth
Internet Search
Another Website
Name of Website: ___________________________________
Other
Describe:__________________________________________
__________________________________________________
Your Name: ___________________________________________
_______________________________________________________
Signature of Group Leader
Submit your form to:
Outreach Mission Staff
The Lighthouse
San Ignacio, Baja Calif. Sur. 23930 Mexico
Mailing Address:
ESMI
PO BOX 28111
Santa Ana, CA 92799 USA
Phone from US: 714-881-1065
Phone from Mexico: 615-154-0223
On the web at: www.esmi-mx.org
Email: missions@esmi-mx.org
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