TRIP APPLICATION, part 1

Friends Forever Ministry Trip

(attach your picture in the upper right hand corner – IT IS REQUIRED)
CLICK for part 2, part 3, part 4 and part 5

I.  Tell us about yourself.  (Please print legibly)

Full Name (as on Birth Certificate/Passport)

Last_______________________First____________________Middle________________

Passport Number____________________________Expiration Date_________________

Physical Address (no P.O. Box)______________________________________________

City________________________________State___________Zip__________________

Home Phone(_______)__________________Work Phone(_______)________________

Cell Phone(_______)___________________Email_______________________________

Birth Date_______/________/_________

Height________feet________inches       Weight_________pounds (do not leave blank)

(circle one)   Male     Female          T-shirt size:    S     M     L     XL      XXL

Marital Status:   Single     Engaged     Married     Separated     Divorced

                                                             Spouse’s Name_____________________________

II.  Tell us who you live with. (Please print legibly)

Father/Guardian

Last Name___________________________________First________________________

Phone(________)____________________Email________________________________

Mother/Guardian

Last Name___________________________________First________________________

Phone(________)____________________Email________________________________

If parents are separated or divorced, who has legal custody?

(circle one)    Father     Mother     Joint     Others_________________________________

III.  Please tell us if you have ever:
Please Circle

Been suspended or expelled from school?          Yes           No

Served time in a detention center or jail?             Yes    No

Been convicted of a crime?                                Yes           No

Been involved with tobacco products?                Yes           No

Been involved with alcohol?                                Yes           No

Been involved with illegal drugs?                      Yes            No

Been involved with gang-related activities?       Yes            No

Been involved with a cult or the occult?               Yes            No

Had diabetes or hypoglycemia?                           Yes            No

Had fainting spells?                                              Yes            No

Had an eating disorder?                                       Yes            No

Had breathing problems?                                     Yes            No

Had psychiatric care?                                          Yes             No

Taken depressions or behavioral medication?       Yes             No




 

Trip Application, part 1

Page 2

Been sexually active? (omit if married)             Yes             No

Been pregnant or fathered a child?                  Yes            No

Been involved in homosexual activities?           Yes            No

Intentionally inflicted harm on yourself?            Yes             No

Attempted suicide?                                         Yes             No

Been treated for physical impairment?             Yes             No

Been treated for mental impairment?               Yes             No

If you answered “Yes” to any of the above, please give a complete explanation on a blank sheet of paper.

IV.  Give us your testimony by answering the questions below. (Please print legibly)

Date you made a commitment to follow Jesus________/________/________

                                                                          Month        Date          Year

Describe your current relationship with God:

Name of Home Church______________________________________________
 

(include city and state)_______________________________________________

Tell us how active you are in your church

Tell us why you want to go on this missions trip.

(use other side of page for writing space and answer in detail)


 

Trip Application, part 1

Page 3

Have you been on a missions trip before?____Where/Date:________________________

 

CIRCLE the 2010 week you are planning to participate"

Authorization:

The information I have given above to Friends Forever Missions & Media aka Mark Muirhead Ministries, Inc. is accurate and true to the best of my knowledge. 

I agree to the responsibilities to uphold the ‘CODE OF CONDUCT’ for the missions trip week.  Additionally, I will take the online training to prepare myself for the trip.

I give Mark Muirhead Ministries, Inc. the right to use my picture, video taping and/or audio taping of me for broadcasting on Friends Forever TV and/or Around The World Radio and/or for promotional and/or advertising purposes. 

My enclosed signature (and signature of my parent or legal guardian because I am under the age of 18) signifies my approval.

Applicant’s Signature_________________________________Date_____/_____/_____

Parent/Guardian Signature_____________________________Date_____/_____/_____

                                    (required if applicant is under the age of 18)

Please return application with a $125.00 non-refundable and non-transferable deposit
before or by December 30, 2010.

Mark Muirhead Ministries, Inc. / P.O. Box 2001 / Pinehurst, NC 28370-2001

PH:  1-910-215-7777 / EM: harpmotive@aol.com