Bishop 3Cs Initiative UMVIM Trip CAMPHOR MISSION STATION Liberia West Africa PLEASE SELECT ONE ___

_ January 2013 UMVIM Trip ___June 2013 Youth Young Adult Cost $ 3000 per person Name__________________________________________________________________ Age _______ Birth date __________________________ Gender: Male Female

Phone (H) ____________________________ (C or W) __________________________ Mailing Address ___________________________________________________________ E-mail __________________________________________________________________ Occupation_______________________________________________________________ Name as it appears on your passport

Passport Number Place of issue

_______________________ _______________________

Date of Issue: __________________ Expiration date : ________________

Delta Frequent Flyer Mile number ______________________________________________

It is absolutely essential that the name of the passenger match the name on the passport EXACTLY! Over the past two years the TSA has become very strict with this. If middle names are on passports, but missing or only an initial on the boarding pass, the TSA agents are sending passengers back to the airline to correct the ticket. The passengers are not getting past security. The airlines when dealing with this are imposing fines to both the passenger and the booking agency correcting the error at the airport. The airline is fined by the TSA for not having the correct information when they send over the passenger list to the TSA 72 hours prior to the flight. And if the current class of service is not available, the passenger can be charged full fare for the new ticket. As you can see, this causes a lot of people a whole lot of problems and the folks at the airport just dont have a sense of humor about this.

IMPORTANT!

Include 1 copy of your passport ID page.

Local Church __________________________________________________ Pastor ________________________________________________________

1. Why do you wish to participate in this mission? (Please use separate page.) Tell about yourself, including local church involvement, hobbies, and any other information that might be useful during this mission. 2. The mission will include some fairly rigorous activity and the hours may be long. Please indicate the general state of your health. Is there anything team leaders should be aware of health-wise (allergies, diet, specific medicines that should not be administered, etc.)? 3. Team members may be asked during church services to give a brief 2-3 minute testimony about their commitment to follow Christ and his impact on their lives. Do you feel certain that with Gods help you will be able to make such a public testimony? 4. Please check all applicable skills and explain in detail, where appropriate. We need a clear picture of your skills/abilities to make the mission team as effective as possible. Team assignments will be made based on this information. ___ Work with children and youth, including recreational skills, storytelling, art, singing, crafts. Which is best for you? _____________________________________ ___Building/carpentry skills. (Some of the team members must have construction knowledge.) Please indicate your level of expertise: ___Fair ___Good ___Excellent ___Professional ___ Medical Technician. ___Physician ___Nurse ___First Aid training ___CPR training ___ Singing in worship services ___Solos ___Duets/trios/small groups ___With total group only ___ Playing a musical instrument (specify)____________________________________ ___ Preaching or giving a prepared talk/devotional ___ Photography/Videography

To be completed by Applicant: I understand that team members must be flexible, cooperative, and cheerful. I agree to cooperate at all times with the Team Leader concerning our life together including daily assignments, food, lodging, and transportation. I agree to stay with the team from beginning to end. ______________________________________________________ ______________________ Applicants signature Date To be completed by Applicants pastor: I believe that the above applicant is a dedicated Christian, is friendly, flexible, and able to make a valuable contribution ot the mission team traveling to Liberia. I am personally acquainted with him/her and recommend her/him for volunteer service. You may contact me for additional information if needed. ______________________________________________________ ______________________ Pastors Signature Date Send completed application to the Mentor UMVIM Coordinator: Becky Suran 11945 Briar Wyck Woods Painesville, Ohio 44067

For further information contact Becky at csuran@adelpheia.net