MISSION COHORT DECEMBER 201 MISSION
To register for the Mission Cohort 2015 December Mission, please follow these steps:

1. Fill in the details below
2. Deposit the mission fee into the MC Bank account bank account which will be sent to you after the form has been received before the closing date (details at the bottom of the form).
3. Scan and send your proof of payment to potchmission@gmail.com, or keep your proof of payment with you until the mission.
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FULL NAME *
DATE OF BIRTH *
MM
/
DD
/
YYYY
GENDER *
CONTACT NUMBER
E-MAIL ADDRESS
HAVE YOU EVER ENGAGED IN MISSION OR EVANGELISM BEFORE?
This information is required for pairing of missionaries.
PLEASE PROVIDE DETAILS IF YOU ANSWERED YES TO THE ABOVE
Which mission? What kind of evangelism? What activities? What role did you play?
ALLERGIES (If any)
Please include details
MEDICAL AID INFORMATION
ADDITIONAL COMMENTS
Information that you think is essential for Mission Cohort to know before the mission
HOME CHURCH/CONGREGATION DETAILS
Please add the details of your Seventh-day Adventist home church/ congregation
HOME CHURCH/CONGREGATION
Where is your membership based?
CHURCH ELDER/ CLERK NAME
Please add the name of your church clerk/elder
CHURCH ELDER/ CLERK CONTACT NUMBER
Please add the cell number of your elder or church clerk
CHURCH ELDER/ CLERK E-MAIL ADDRESS
Please add the e-mail address of your church elder or church clerk
NEXT OF KIN DETAILS
NAME AND SURNAME
Details of Next of Kin
CONTACT NUMBER
RELATION
E.g. "Mother"
ACCOUNT DETAILS
Please deposit the mission fee into the following account:

Bank:               FNB
Acc. holder:      Mission Cohort Group
Acc. Number:    62403249859
Branch code:    251445
Reference:       “MISSION – [NAME & SURNAME]“
                       (Example: "MISSION - JAMES WHITE")

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