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Detroit Trip Registration Form 2018
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First Name
Your answer
Last Name
Your answer
Mobile phone number (where we can reach you while on the trip)
Your answer
Email address
Your answer
Congregation
Your answer
I have been on a mission trip before
Yes
No
Clear selection
I have a medical condition that others should be aware of.
No
Yes. I will let the coordinator from my congregation and/or my roommate know.
Clear selection
Emergency Contact Name
Your answer
Emergency Contact Home Phone Number
Your answer
Emergency Contact Mobile Phone Number
Your answer
Emergency Contact Relationship to You
Your answer
My skill level in Carpentry is
No experience
Can do with direction
Can work independently
Can lead others
I am a professional
Clear selection
My skill level in Painting is
No experience
Can do with direction
Can work independently
Can lead others
I am a professional
Clear selection
My skill level in Drywalling is
No experience
Can do with direction
Can work independently
Can lead others
I am a professional
Clear selection
My skill level in Roofing is
No experience
Can do with direction
Can work independently
Can lead others
I am a professional
Clear selection
My skill level in Electrical is
No experience
Can do with direction
Can work independently
Can lead others
I am a professional
Clear selection
My skill level in Plumbing is
No experience
Can do with direction
Can work independently
Can lead others
I am a professional
Clear selection
My skill level in Landscaping is
No experience
Can do with direction
Can work independently
Can lead others
I am a professional
Clear selection
Other skills I have include:
Your answer
I am interested in helping to document the trip (photography, writing, filming, etc)
Yes
No
Clear selection
I would feel comfortable leading a team of volunteers from different congregations
Yes
No
Clear selection
I plan to room with
A family member
A specific person on the trip
I will need you to assign me a roommate.
I would like a room to myself at the additional cost of $200.
Clear selection
If you plan to room with someone specific, please provide his/her name
Your answer
If you need to have a roommate assigned, please select your gender for planning purposes.
Female
Male
Clear selection
Any special needs for lodging or meals?
Your answer
Please reserve a place for me for the Saturday excursion (at an additional cost).
Yes, please.
No, thank you.
Clear selection
Please order a photo book for me. Books cost $15 and will be available towards the end of 2018.
Yes, please.
No, thank you.
Clear selection
Submit
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