Trip Applying For*Name* First Last Date of Birth* Date Format: MM slash DD slash YYYY Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Cell PhoneHome PhoneEmail* I have a valid passport*YesNoLanguages SpokenIndicate degree of fluencyT-Shirt Size*SmallMediumLargeXLXXLWhy do you want to participate in this missions trip?*In what work area do you feel you can make the greatest contribution?*What are some concerns over joining this team?*Describe medical conditions a doctor may need to know about.*Emergency Contact* First Last Emergency Contact Phone*Emergency Contact Relationship*How long have you attended Cornerstone?*Ministry CommitmentsPlease list your current ministry commitments at Cornerstone and those which you will be involved in during the mission classes and trip, including a detailed description of its frequency.I Agree:* I will submit the non-refundable deposit for this trip ASAP. I will attend all missions trip training sessions. I will attend a pre-trip interview with a missions leader. All information in this form is correct.