ENCOUNTER MISSIONS INTERNATIONAL
2320 E. BASELINE RD ST 148 #215 PHOENIX AZ 85042
PARTICIPANT APPLICATION
Name: ______________________________________________ Age: _______
Birth Date: ______________ Highest Grade completed: ________________
Address: _______________________________________________________________
City: ________________________________ State: ___________ Zip: ______
Country: _______________________________
Home Phone: ___________________ E-Mail: __________________________
Work Phone: ____________________ Fax: ___________________________
Father’s Name: _________________ Mother’s Name: __________________
Insurance / Policy # ______________________________________________
Group/Church Name: _____________________________________________
Group Leader: ___________________________________________________
Project Location: _______________________ Project Date: _____________
I WILL: Prepare for this mission and follow all rules in a Christ-like manner with a servant’s attitude.
Follow safety precautions during the project.
Follow the dress code for my mission area.
Not use bad language, tobacco, drugs or alcohol on the mission project.
Follow the terms or my leaders may send me home at my own expense.
Signed: ________________________________________ Date: ___________
I give permission for medical attention to my teen while on Encounter Missions International.
Guardian Signature: __________________________________ Date _______
__ $50 Deposit Enclosed
_________________________________________
E.M.I., ENCOUNTER MISSIONS INTERNATIONAL
2320 E. BASELINE RD ST 148 #215 PHOENIX AZ 85042 Tel: 602-791-5578
Fax: 602-276-5252
E-MAIL: POWERHOUSEAZ@JUNO.COM
"MISSIONS AROUND THE WORLD IN JESUS NAME"
