July 5-18, 2011
Mission Trip
Registration Form
15074 Southwest 127 th Court - Miami, Fl 33186
Office: (305) 278-2395 - Fax: (305) 278-1528 cmorris@bellsouth.net
Dear Prospective Team Member:
Thank you for your interest in being a part of the Sanctuary of Moses mission trip to Benin July 5-18, 2011.
Please complete the following information and return to Sanctuary of Moses by May 22, 2011.
You will need to obtain a Benin Visa if you have not already applied for it. A shot (inoculations) list must accompany your visa. Benin Visa Application with $100 (U.S.) and your Passport must be sent to the Benin
Embassy in Washington, DC in order to acquire this Visa. After completing the registration form, attach the required deposit of $1,500.00. Checks can be made payable to Sanctuary of Moses Ministries.
As a team member of this mission trip, you can receive donations from sponsors to assist with your trip expenses. SOM will provide you with information about writing letters, calling, and following up with your potential donors. Because of IRS rules for non-profit organizations, contributions from donors are not refundable to you or your donor.
Your involvement is very important to us. Sanctuary of Moses is in the process of building Christian schools, homes, and providing assistance to children who face daily challenges of traffickers in West Africa. Together we can make a positive difference this summer by ministering to children through medical outreach and launching construction of a classroom and clinic. During our last mission trip to Benin, we sponsored Vacation
Bible School and we saw approximately 2000 children come to the Lord.
With Appreciation,
Carmen Morris
Carmen Morris
Founder
APPLICATION INSTRUCTIONS:
1.
Complete the Application Form.
2.
Attach a recent passport size PHOTO to the Application Form.
3.
Attach the required DEPOSIT to the Application Form (Make checks payable to Sanctuary of
Moses Ministries).
4.
Submit your application on or before the application deadline May 22, 2011. Mail to: Sanctuary of
Moses 15074 SW 127 CT Miami, FL 33186.

*Deadlines and rates are subject to change based on travel or travel agency requirements.
THIS APPLICATION FOR: Benin, West Africa July 5-18, 2011
GENERAL INFORMATION: (please print)
**FULL NAME (This is the name we will use for your airline ticket, so it must be
EXACTLY as it appears on your passport)
Address
City
Home Phone
E-mail Address
State
Work Phone
Zip Code
Cell/Pager
Marital status
Date of Birth
Nickname
Do you have a valid passport?
Age Male or Female
Citizen of what country?
Issued by what country?
Passport # Expiration Date of Passport
Benin Visa# ___________________ Expiration Date of Benin Visa
HEALTH INFORMATION:
1.
Do you have or have you ever had: ❒ Fainting Spells ❒ Heart Problems ❒ Diabetes
❒ Respiratory Problems ❒ Seizures ❒ Eating Disorder
2.
Do you have any condition that might affect your ability to fully function as a team member on this trip (e.g., fears of flying, depression, anxiety, sleep disorders)?
3.
Are you a vegetarian? Please describe any and all special dietary needs you have (no milk products, no meat, need for specially schedule meals, etc.)
4.
Do you have any chronic illnesses or allergies? ❒ Yes ❒ No
5.
Are you presently taking medication prescribed by a doctor?
If so, which medications?
6.
Have you ever had any psychiatric care or treatment?
7.
Please list any hospitalization history. _________________________________________
8.
Does your health insurance cover you overseas?
9.
How would you describe your health and fitness?
❒ Excellent ❒ Good ❒ Average ❒ Below Average

* You may be required to provide a doctor’s letter of “clearance” before traveling.
Applicant Name: _____________________________
SPIRITUAL INFORMATION:
1.
Is OCPC your home church? _____ If not, where do you attend? _____ _____________
2.
How long have you attended church? _________ Which services do you attend?
3.
Have you participated in any Mission Training? have you completed?
If yes, which classes
_______________________
4.
What ministries are you involved with at church?
________________________________________________________________
5.
Do you serve in a volunteer/leadership role in any ministry at church or outside the church?
_______
___________________________________________________________________
6.
Have you participated in or taken Everyday Evangelism training at church?
_______________________
7.
What are your spiritual gifts? _______________________________________________
8.
Name a pastor or leader at church who could give you a reference. ________________
9.
List two people who know you and your spiritual walk (name and phone number).
___________________________________________________________________
___________________________________________________________________
10.
Please describe how and when you came to know the Lord.
11.
Have you been water baptized? If yes, where and when?_________________________
12.
Have you ever served on a mission trip or had a cross-cultural experience?

Applicant Name: _____________________________
13.
If yes, where and when?
14.
Explain why you want to go on this trip.
15. Check your proposed volunteer participation: _____V.B.S _____ Medical _____ Media
___ Other (please explain)
______________________________________________________________
WORK EXPERIENCE/TALENTS:
1.
Please list any talents that you have (drama, singing, instruments, medical, teaching, construction, etc.)
2.
Where are you employed?
What do you do?
3.
Do you speak any foreign languages fluently?
4.
What do you see as your strongest character quality and why?
How long?
5.
What do you see as your weakest character quality and why?

Applicant Name: _____________________________
PERSONAL INFORMATION:
1.
What are your personal expectations for this trip? What would make this trip a success for you?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________
2.
If you are dating or engaged to someone, is this person applying to be a part of this team?
3.
Do you consider yourself: ❏ Introvert ❏ Extrovert ❏ Intuitive ❏ Decisive
❏ Fact Oriented ❏ Perceptive ❏ Feeling ❏ Intellectual
4.
How does your family feel about your participation on this trip? Was their response to your decision enthusiastic, skeptical, negative, or supportive?
___________________________________________________________________
___________________________________________________________________
5.
Have you been involved with any of the following within the past year?
Alcohol? ❒ Yes ❒ No Illegal drugs? ❒ Yes ❒ No Criminal activity? ❒ Yes ❒ No
Tobacco? ❒ Yes ❒ No Cult or the occult? ❒ Yes ❒ No
6.
Have you ever been convicted of a crime? ❒ Yes ❒ No If yes, please explain.
7.
I have reviewed the schedule of team meetings, and I commit to attend ALL scheduled meetings.
❒ Yes ❒ No If you can’t attend a meeting, please indicate reason why? ____
___________________________________________________________________
8.
What are the most significant events that have occurred in your life in the past two years?

Applicant Name: _____________________________
9.
Do you have any questions or concerns regarding this trip that you would like answered at this time?
Sanctuary of Moses requires strict compliance with rules and regulations, including the rules concerning conduct, dress, and Christian lifestyle. Team members, leaders, and staff serve at their own risk; also SOM is not liable in the event of sickness, accident, death, or terrorists acts. SOM are also not liable for transportation and any other expenses beyond normal involvement. Application fees and all sponsor funds received by SOM are contributions and are not refundable. To receive a tax deduction, the IRS stipulates that the donor must release control of all funds donated to a non-profit organization. For this reason, contributions from sponsors cannot be refunded, nor can they be designated to any specific person. Team members may raise funds and receive credit for these funds equal to the price of his or her trip all additional funds will be used for the supplies for this trip. We require all participants to be in good physical condition, and we may require a doctor’s reference and exam. I have read and understand the above information. The information I have given is accurate and true to the best of my knowledge. My signature signifies my approval of all limitations listed above.
Signature of Applicant: Date:
*UNDER 18 Years old parent(s) signature required with notarization.
Signature of Parent(s): Date:
Date:
Signature of Guardian: Date:
Sanctuary of Moses• 15074 SW 127 CT Miami, FL 33186•305-278-2395• www.sanctuaryofmoses.org