Trip Application Select a Trip/Date(Required)Hope Work Crew February 11-18 2024Vintage Church Trip June 2-9 2024GStudents Trip June 16-22 2024Christ the King Trip July 28-Aug 3 2024Plymouth Church Trip October 20-26 2024First & Middle Name (as they appear on your passport)(Required) Last Name (as it appears on your passport)(Required) Birthdate(Required) MM slash DD slash YYYY Please list your preferred airport(s) in order of preference. (ie: the airport(s) you want to fly out of)(Required) Do you have a current US Passport? (If not - please apply for one now. You cannot travel to Nicaragua without one)(Required)YesNoPassport Number(Required) Street Address(Required) City(Required) State(Required)- Select State -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingWashington DCARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EASTARMED FORCES AMERICA (EXCEPT CANADA)ARMED FORCES PACIFICCountryOneTwoThreePhone(Required)Email(Required) Gender(Required)FemaleMaleHow did you hear about this trip?(Required) Have you had previous experience on the mission field or traveled in a foreign country?(Required)YesNoIf yes, please list countries and experienceWhat are your expectations for this trip?(Required)Please describe your health, including physical or dietary limitations(Required)Are you on regular medications or currently under a doctor's care?(Required)YesNoIf yes, briefly explainPlease list any allergies (food, medicine, environment, insect, etc.)(Required)Date of Last Tetanus (skip if you don't know) MM slash DD slash YYYY Blood Type (skip if you don't know) This trip may require strenuous physical activity for extended periods of time. Do you have any conditions (medical or otherwise) that may prevent you from fully participating?(Required)YesNoIf yes, please briefly explainPlease list any medical, First Aid, or CPR trainingPlease list any special talent or gifting that may be utilized on the trip(Required)Is there anything else we should know about you?Emergency Contact #1(Required) Emergency Contact #1 Email(Required) Emergency Contact #1 Phone(Required)Emergency Contact #2(Required) Emergency Contact #2 Email(Required) Emergency Contact #2 Phone(Required)Today's Date MM slash DD slash YYYY By checking this box I acknowledge and warrant that the information that I have provided on this form is true and correct to the best of my knowledge. I further agree to immediately notify SuNica of any change in the information presented. I understand that this form is valid and legally binding.(Required) I agree I understand that completing this form requires a $250 trip deposit (which can be paid by clicking the button below and selecting "Trips Payment" on the dropdown menu)(Required) I agree Pay Trip Deposit