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1. Full Name

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2. Email address

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3. Telephone number (###-###-####)

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4. Home address

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5. City

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6. State

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7. Country

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8. Zip code

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9. Birth date (mm/dd/yyyy)

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10. Age

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11. Gender

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12. Passport Number

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13. Expiration Date

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14. Are you a US Citizen?

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15. Marital Status:

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16. If married, is your spouse accompanying you on this trip? 

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17. Spouse's name (IF accompanying you on this trip)

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18. How did you hear about LOL Ministry?

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19. Emergency Contact #1

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20. Telephone number (###-###-####)

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21. Email address

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22. Relationship

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23. Emergency Contact #2

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24. Telephone number (###-###-####)

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25. Email address

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26. Relationship

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27. Church name

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28. Address

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29. Telephone number (###-###-####)

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30. Denomination

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31. Has a representative from LOL ever visited your church?

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32. What is your primary reason for participating in a short-term mission trip?

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33. Requested dates for your trip:

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34. Are your dates flexible?

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35. If yes, how flexible are they?

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36. (Optional) 2nd choice of dates:

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37. Preferred # of days doing construction:

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38. Preferred # of days doing ministry:

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39. What kind of group/organization are you?

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40. Total # of members in your group (including leaders):

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41. Age range of members:

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42. Total # of male participants (excluding leader):

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43. Total # of female participants (excluding leader) 

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44. Total # of male leaders:

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45. Total # of female leaders: 

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46. Please list the names of the leaders (IMPORTANT: if there are both male and female participants in your group, you must have both male and female leaders.)

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47. Total # of married couples:

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48. Please provide the names of each married couple:

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49. Please list any special needs (i.e. specific allergies to foods/plants/etc..illness, handicaps, etc.) for any member of your group that LOL should be aware of: 

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50. What do you hope to gain for your team during your time at LOL?

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