MISSION TRIP APPLICATION
Country for which you are applying: ___________________Trip Date:___________________________
Name: (As it appears on your passport)__________________________________________________
Address:_________________________________City__________________State__________Zip_______
Telephone: (Home)______________(Work)______________________(Cell)_____________________
Email address:______________________________Passport#_______________Date of Birth:_________
Place of Birth: ________________________If you are not a US citizen, in what country do you hold
Citizenship? _______________________What languages do you speak?___________________________
Who would you like to name as beneficiary on your Traveler’s Insurance Policy?______________________
Area of Interest: (Medical, Construction, Humanitarian/Social Outreach, Micro-enterprising, Other)
If you are a physician, please forward a copy of your medical license and DEA certificate to “Bridges of Hope” office.
REQUIREMENTS
1. You MUST have a valid passport that will not expire for 6 months or greater from your travel date.
2. Please send a copy of the Declaration Page of your passport to the “Bridges of Hope” office.
3. A deposit of $150 will confirm your reservation. By law the IRS considers this as an unrestricted donation which
is non refundable should you be unable to complete your travel plans. The money will be used for mission trip
expenses, such as medications, supplies, food and clothing outreaches. Checks should be payable to: “Bridges of
Hope International”.
4. The balance of your trip payment must be received no later than 60 days before departure. Should you need an
installment plan, please contact us for assistance.
How would you describe your spiritual journey?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
What has motivated or inspired you to be a part of this cross-cultural team? _______________________________
What are your personal goals/expectations for this trip?_______________________________________________
If you attend church, where do you attend?_______________________________________
Bridges of Hope International is a 501-C3 charitable organization. All donations are tax deductible.