2012 DRMT Application

2012 DR Mission Team

INSTRUCTIONS: This application is required for every member of the 2012 DR Mission Team. It is vital information needed to secure plane tickets, organize work teams, and keep everyone healthy and safe while in the DR. This application and your non-refundable deposit of $100 are necessary to reserve your spot on the trip.

Please fill out the form below and hit submit. By submitting this form, you are verifying that all information is accurate and correct.

Questions? Please email or call 203-626-2239.

First Name *

Last Name *

Name as it exactly appears on passport *

If you are applying for your passport, please list here the name you will use on your passport. This has to be exactly as it will appear on your passport as it will be used with the airline for your airline ticket.

Country of Passport

Passport Number

If you do not have your passport number, please leave blank and email to passports@drmissionteam.org as soon as you receive it.

Passport Expiration Date

If you do not have your new passport back yet with expiration date, please leave blank and email to passports@drmissionteam.org as soon as you receive it.

Address *

Town *

State *

Zip Code *

Phone Number *

E-mail *

Birthdate *

DD/MM/YYYY

Gender

Shirt Size

Small, Medium, Large, XL, XXL

Church Affiliation (if applicable)

Pastor's Name

By submitting this form, you accept the Mollom privacy policy.

2012 DR Mission Team

Batey 50 Day

1990 - 2012 Teams

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2012 DR Mission Team

Batey 50 Day

1990 - 2012 Teams

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2012 DRMT Application