REGISTRATION

HOME
MISSIONS
ABOUT US
JOURNAL
REGISTRATION
DONATE

REGISTRATION

You can make a difference today. It starts with believing things can change.

REGISTRATIONHitesh Kewalramani2024-07-19T01:12:12-05:00

Download the File and then Upload the completed form

Click here to Download the Application

Please enable JavaScript in your browser to complete this form.

File Upload

Click or drag a file to this area to upload.

OR FILL OUT THE FORM BELOW

Please enable JavaScript in your browser to complete this form.

- Step 1 of 2

Date / Time

Name (Exactly as it appears on your passport) *

Gender

Male
Female

Title

Dr.
Mr.
Mrs.
Ms.
Rev.
Other

Address

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address (if different)

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone

Current Profession

Employment Address

Address Line 1

Address Line 2

City

State

Zip Code

Marital Status

Single
Married
Divorced
Widow(er)

Spouse Name *

Passport Number

Passport Authority

Country of Citizen

Nationality

Date of Birth *

IMPORTANT: Airport you will be flying out from

Have you participated in a SMI trip before?

If Yes, When and Where?

Insurance: Every trip participant is enrolled by SMI in a medical & life insurance plan specifically designed for short-term missionaries. Please provide the following information: Name of beneficiary for life insurance purposes:

Relationship of beneficiary:

Insurance Name

Policy Number

Do you have any physical or emotional disabilities that would affect your trip participation?

Golf Shirt Size

Small
Medium
Large
XL
XXL

Emergency Contacts

Name *

Relationship

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Are you fluent in Language(s)? Please list them below

Signature

Clear Signature

Updating preview…

This is a preview of your submission. It has not been submitted yet!
Please take a moment to verify your information. You can also go back to make changes.

810 Thuderbrid Drive Florence SC 29501

randy.shell@icloud.com

843-413-1919

Page load link

Go to Top

You can make a difference today. It starts with believing things can change.

Download the File and then Upload the completed form

Click here to Download the Application

OR FILL OUT THE FORM BELOW

Emergency Contacts