General information

Name

Age

Address

City

State

  Zip code

Phone
(office)

Phone
(home)

Fax

E-mail

Congregation

Region
or school

Select training event

October 24-27, 2007 Louisville, Ky.
Registration deadline: October 3, 2007

March 24 to 29, 2008, White Swan, Wash.
Registration deadline: February 20, 2008

Specific information

Please say something about the skills you offer this trip (carpentry, landscaping, specific skills, and/or your willingness to learn):

Medical concerns we should be aware of?

Date of last tetanus shot (You will want to have one for this trip if yours is expired):

Any dietary needs we should know about (including vegetarian)?

Tell us briefly about your church's mission/work trip program.

Tell us briefly about your experience leading mission/work trips.

How did you find out about this trip?

Name

Address

City

State

  zip code

Phone
(office)

Phone
(home)

Company

policy/group holder

The cost of this trip (excluding airfare/travel expenses) is $125. We must receive payment by the trip deadline (posted above with trip date). Earlier is better. Make checks payable to Disciples Home Missions. Send payment to: Office of Disciples Volunteering; P.O. Box 1986; Indianapolis, Ind. 46206.
I have read and understand the above statement.