CAMBODIA 2018 - Azmera Haven Retreat VOLUNTEER Application

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* 1. Contact Information

First Name (as you would like it on your name tag) *

Last Name

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country

Email Address *

Phone Number *

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* 2. Spouse Information (if applicable)

First Name

Last Name

Email Address

Phone

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* 3. Emergency Contact

Name:

Relationship:

Phone:

Email Address:

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* 4. Health

Health Concerns

Diet Restrictions and Allergies

Birthdate (mm/dd/yyy)

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* 5. Travel Information

Full Name on Passport:

Passport #:

Date of Issue:

Date of Expiration:

Nationality:

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* 6. Church Information

Name of Church:

Denomination:

How long have you attended:

In what ways are you involved at your church:

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* 7. Reference Information: Please include 3 references (church staff, small group leader, and/or a friend/personal reference):

First Reference Name:

Position/Relationship:

Email:

Phone:

Second Reference Name:

Position/Relationship:

Email:

Phone:

Third Reference Name:

Position/Relationship:

Email:

Phone:

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* 8. Why would you like to volunteer for this retreat?

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* 9. Please share a brief testimony of how you came to know the Lord:

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* 10. Have you had previous experience in missions (short or long term) or done any international travel? If yes, please tell us a little about your experience:

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* 11. What skills or talents do you have that you feel you could share at this retreat (counseling, praying, listening, encouraging, hair styling, massage, medical, physical therapy, nutrition, foreign language, music, art, jewelry making, journaling, etc.)? Would you be willing to be trained to give pedicures?:

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* 12. How did you learn about Azmera?

Thank you for your application! We will respond shortly.

Blessings!