Mission Assignment

Name (as it appears on passport)_________________________________________ DOB:___________

Preferred name:_______________________________

Address________________________________ City_____________________ State/Zip_____________

Telephone:H_________________________ Cell___________________________

E-mail:______________________________ Fax____________W_____________

Best time to reach you is:________________________________________________

Notification in case of emergency:

1. Name_________________________________ Relationship _______________________

Address_______________________________ Phone # __________________________

Work # __________________________ _____ Cell # ___________________________

2. Name_________________________________ Relationship _______________________

Address_______________________________ Phone #___________________________

Work # __________________________ _____ Cell # ___________________________

I have a current Passport YES p NO p If you do not yet have a passport, let us know when it comes.

If Yes, what is the expiration date?_________ Passport #______________________

Health Conditions treated in last 5 years, and state of current health: _____________________________________________________________________________________

_____________________________________________________________________________________

How did you hear about FOMMM?_________________________________________________

Do you speak any other languages?_______________________________________________

Have you heard of The Way of The Master?____ Would you like to be part of the evangelism team?a____ (this is not mandatory)

Summarize any Previous mission experiences: _____________________________________________________________________________________

_____________________________________________________________________________________

What prompted you to want to go on this mission?_____________________________________________________________________________

What special talents or experiences do you have to bring to the team.____________________________

___________________________________________________________________________________

Summarize your professional experience: ___________________________________________________________________________________

___________________________________________________________________________________

Certifications/Licenses

1. ____________________________________________

2. ____________________________________________

3. ____________________________________________

Please attach copies of any pertinent diplomas, certifications or /licenses.

Are you a born again Christian, and how did you get saved?_____________________________________________________________________________

___________________________________________________________________________________

____________________________________________________________________________________

References:

1. Name__________________________________________

Address________________________________________

City__________________ State/Zip__________________

Telephone: H___________________

W ___________________

2. Name__________________________________________

Address________________________________________

City__________________ State/Zip__________________

Telephone: H___________________W_______________

I hereby agree that I will not hold FOMMM nor any representative thereof, legally responsible for any accident, sickness, injury, dismemberment, death or loss of property while on one of the mission teams or enroute to or from the mission field.

Signed__________________________________________________ Date___________________

Make a copy of this form for your records. If you plan on being part of the evangelism team, call and let us know soon.