PEACE Trip Application
Thank you for your interest in short-term missions! To help us get to know you better, each adult or student applying needs to fill out a separate application.
The application consists of 5 pages & will take approximately 15-20 minutes to complete.
Contact Info
*
First Name
*
Middle Name
*
Last Name
*
Street Address
Address Line 2
*
City
*
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
*
Zip Code
*
Phone Number (HOME)
Phone Number (CELL)
Phone Number (WORK)
*
Email Address
Please email me updates
Personal Info
*
Marital Status
Marrried
Single
Divorced / Separated
In a relationship
Other
If married, Spouse's name:
*
Place of Employment
Job Title:
*
Date of Birth
*
T Shirt Size
*
Do you have any allergies or medical conditions that we need to be aware of?
*
Are you taking any medications?
Passport Info
*
I have a current passport
Yes
No
If yes, Passport Number:
Passport Expiration Date
*
Indicates Response Required