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VRBC Indonesia Mission Trip Registration 2018
Preparation:

You will need to complete this online application in one sitting, as there is no way to return to the application once you have started it. In order to complete this application, you will want to have the following information handy:

Passport (Exact Name, Number)
Travel Insurance Beneficiary (Name, Address, Phone)
Emergency Contact (Name, Phone, Email)
Someone to notify in case of flight delays or changes (Name, Phone, Email)
Health Insurance Information (Carrier, Policy/Group #, Phone)
Prescription Medications
Contact Info for 2 References (Name, Phone, Email)
Once you have this information, you may complete the application.

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Email *
Cancellation Policy: Once you have been selected for a mission trip, your mission trip deposit becomes non-refundable. Additionally, in some cases the cost of the airline ticket will be charged to you, if you cancel after airline tickets have been purchased. Do you agree to abide by this cancellation policy? *
Personal Information:
Title: *
Name exactly as it appears on passport: *
Gender: *
Address: *
Home Phone:
Work Phone:
Cell Phone *
Email: *
Birthdate (MM/DD/YYYY): *
MM
/
DD
/
YYYY
Place of Birth: *
Citizenship: *
Please provide two copies of your passport to Arthur Mendes
Passport Number: *
Passport Expiration: *
MM
/
DD
/
YYYY
VRBC member? *
Grow Group Member? *
Grow Group Leaders:
Marital Status: *
Spouse Name:
Occupation: *
Employer
Skills (Training, Experience, Hobbies, etc): *
Beneficiary:
For your protection, we will be purchasing mission trip travel insurance through Gallagher Charitable International Insurance Services. For insurance purposes, please list beneficiary.
Beneficiary Name: *
Beneficiary Address: *
Beneficiary Phone: *
Relationship: *
Emergency Contact
In case an emergency should occur, please notify:
Name: *
Phone: *
Email:
Notify
In case your travel plans are disrupted by a flight change, whom should we notify?
Name: *
Phone: *
Email:
Health Information
Health Insurance Carrier: *
Health Insurance Policy/Group Number: *
Health Insurance Carrier Phone Number: *
Please list any chronic health conditions, physical limitations, disabilities or restrictions:
If you are currently taking any prescription medications, please bring a copy of your prescription with you on the mission trip.
Please list any prescription medication you are currently taking:
Please list any allergies:
Other:
Do you speak any language besides English? *
If YES, please list language(s) and proficiency: *
Have you ever traveled outside of the United States? *
If you have ever participated in a mission trip, please briefly describe your experience:
Do you have a roommate preference?
Have you ever been convicted of a crime, other than a minor traffic violation? *
If YES, please explain:
Payment Plans
Please select all that apply
How will you be paying for your trip? *
Required
If you receive financial assistance from VRBC for your mission trip, we ask that you not solicit additional support from VRBC members. You are welcome to solicit support from family and friends outside of VRBC.
If you would like to see a sample fundraising letter, please see http://vrbc.net/about/resources/
References
Please list two individuals from this church who could be contacted for a personal reference. AT LEAST ONE SHOULD BE FROM A PASTOR OR GROW GROUP LEADER. Please take time to see that the phone number and email you provide are correct.
Pastor or Leader Name: *
Pastor or Leader Phone: *
Pastor or Leader Email: *
Name: *
Email: *
Phone: *
Training
The training curriculum and meetings for this mission trip are critical, ensuring success for your entire team. Please mark your calendar and plan to attend these four sessions to be held at VRBC on:

- January 28, 12:30 to 2:00 pm
- February 18, 12:30 to 2:00 pm
- June 10, 12:30 to 2:00 pm - Orientation
- September 9, 12:30 to 2:00 pm - Celebration
Do you commit to complete the missions trip training curriculum and to faithfully attend the mission trip meetings? *
Guidelines and Commitment:
1. The church is not responsible for accidents, diseases, or other maladies incurred during this mission trip.
2. The church staff and team leader for each mission trip will have final authority in all decisions made during the trip.
3. Loss of money due to cancellations must be incurred by participants, not the church. Trip costs are based on estimates of anticipated expenses and may actually be more or less than actual expenditures. Any funds over the total trip cost for a participant will be used for related ministry purposes at the discretion of the Missions Leadership Team. Trip participants cannot ask for a refund of this overage.
4. I agree to attend all required training sessions and complete any requirements according to the timetable set by the team leader.
5. I will conduct myself in a manner worthy of the Lord while serving on this project.
6. I will refrain from any behavior which may compromise my witness (i.e. abusive language, drugs, alcohol, or tobacco use, etc).
7. If at any time while on the mission trip my behavior constitutes a problem, the team leader has the authority to ask me to return home. Any additional cost incurred as a result of this action will be at my expense.
I agree to honor these commitments: *
I understand that I will have to pay a $ 150 deposit on January 15, 2018 and the total balance due until June 1, 2018 *
Required
You can pay by check payable to VRBC with “2018 (designated) Mission Trip” in the memo line. Or you can pay online at http://vrbc.net. You would click “Give to VRBC” in the upper right corner and log into Fellowship One with your information, then click “Give Now” on the right side. At the top it says, “Please specify where you would like to give” you would select “Mission Trip.”
A copy of your responses will be emailed to the address you provided.
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