2021 Office for World Mission Sankofa Pilgrimage

1. Ghana Pilgrimage October 7 -21, 2021

Please complete all fields in this online application before the due date of May 15, 2021.

Your initial, non-refundable deposit of $350 is also due by May 15, 2021.

(If you have technical problems with the survey, please contact Beth at 414-758-2280. If you have questions about the program, please contact Antoinette Mensah at 414-758-2282)

PAGE 1: PERSONAL INFORMATION:

Question Title

* 1. Please provide your contact information:

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

Question Title

* 2. What is your religious affiliation?

Question Title

* 3. What parish/church do you belong to?

Question Title

* 4. What is your date of birth? (please use format MM/DD/YYYY)

Question Title

* 5. Do you have a valid passport?
Note: Passport must be in hand by August 1, 2021 to allow for Visa processing. Passport must not expire for at least 6 months after the return date of your trip (it must be valid until at least the end of April of 2022).

Yes, from the US (see Question #6)

Yes, I have a passport from another country. (Please see question 6. The World Mission Office will follow up with you for more information)

No (see below)

If you do not have a passport, have you begun the application or renewal process for one?

Question Title

* 6. If you already have a valid passport, please enter the following information:

Issuing Country:

Full name exactly as it appears on your passport:

Passport Number:

Question Title

* 7. Emergency Contact Person(s):
(At least one person's name and phone or e-mail address are required.
Note that your Emergency Contact Person cannot also be on the pilgrimage.)

Contact Person #1 Name:

Contact Person #1 Telephone Number:

Contact Person #1 E-mail Address:

(optional) Contact Person #2 Name:

(optional) Contact Person #2 Telephone Number:

(optional) Contact Person #2 E-mail Address:

Question Title

* 8. Do you have any health or dietary restrictions?

Yes (please specify)

Rooming Preference:

Please note the following before answering the questions about occupancy:

Single Occupancy will mean your own room and is a $600 additional charge.
Double Occupancy will generally mean a room with two twin beds, but in some hotels it may mean sharing a bed (queen size) with your roommate or one of you sleeping on a mattress on the floor. Choosing Double Occupancy means that you understand and are comfortable with this arrangement when necessary.

Question Title

* 9. Rooming Preference:

Double Occupancy (Please see Question 10)

Single Occupancy (Skip to Question 11)

Question Title

* 10. If you have chosen Double Occupancy, please indicate your roommate situation:

I have a roommate with whom I would like to stay (Please indicate name of roommate in additional information field below).

I do not have a roommate and am open to being paired with someone to meet the double occupancy requirement. (Please indicate any special circumstances in the field below).

Additional Information (Name of Roommate, or, if you do not have one, please indicate anything we should know before placing you with a roommate)

Question Title

* 11. For single occupancy or double occupancy without a roommate, please indicate your understanding of costs by choosing the appropriate answer, below:

I understand that I have chosen single occupancy and there is an additional $600 cost for my trip.

I understand that a roommate match will be sought for me. However, if a roommate match is unavailable, I understand I will be charged the single occupancy rate.

Question Title

* 1. Please provide your contact information:

Question Title

* 2. What is your religious affiliation?

Question Title

* 3. What parish/church do you belong to?

Question Title

* 4. What is your date of birth? (please use format MM/DD/YYYY)

Question Title

* 5. Do you have a valid passport? Note: Passport must be in hand by August 1, 2021 to allow for Visa processing. Passport must not expire for at least 6 months after the return date of your trip (it must be valid until at least the end of April of 2022).

Question Title

* 6. If you already have a valid passport, please enter the following information:

Question Title

* 7. Emergency Contact Person(s): (At least one person's name and phone or e-mail address are required.Note that your Emergency Contact Person cannot also be on the pilgrimage.)

Question Title

* 8. Do you have any health or dietary restrictions?

Question Title

* 9. Rooming Preference:

Question Title

* 10. If you have chosen Double Occupancy, please indicate your roommate situation:

Question Title

* 11. For single occupancy or double occupancy without a roommate, please indicate your understanding of costs by choosing the appropriate answer, below:

* 5. Do you have a valid passport?
Note: Passport must be in hand by August 1, 2021 to allow for Visa processing. Passport must not expire for at least 6 months after the return date of your trip (it must be valid until at least the end of April of 2022).

* 7. Emergency Contact Person(s):
(At least one person's name and phone or e-mail address are required.
Note that your Emergency Contact Person cannot also be on the pilgrimage.)