DR Trips Interactive Form

Germantown Baptist Church
Dominican Republic Trip Registration
Sunday, May 30 - Saturday, June 5, 2010

Last Name:		First Name:
Middle Name or Initial:		Date of Birth:
Gender:		Marital Status:
Street Address:
City: State: Zip:
Daytime Phone#:		Evening Phone#:
E-mail Address:
If under 18, legal guardian:
Spouse's Name:
A PASSPORT IS REQUIRED. You will no longer be able to go with just a birth certificate. A copy of your passport must be filed with the Missions Office.
Full name as listed on passport:
What name do you want on your DR name tag?
Passport #:		Passport expiration date:
Passport country of issuance:		Citizenship of what country:
Country of Residence:
Emergency Contact Information
Emergency Contact Name and Phone Number:
For insurance purposes, who is your beneficiary and their contact information?
Are you a member of GBC?		If no, where are you a member?
Airline Flight Information
City, Date and Time of Departure:
Airline Flight#		Arrival time:
City, Date and Time of Return:
Airline Flight#		Arrival Time:
Check your area of interest
Evangelism Dental Sports Crafts Construction Translator Medical
Roommate Preference:

Listed below are forms you are required to fill out before you go on the DR trip. Please download the appropriate one.

for adults over 18 please click here

for minors under 18 please click here