Spartanburg Angels mission, schools, pediatric clinic.

APPLICATION FOR MISSION TRIP TO HONDURAS

December 15 -22, 2007

The cost of the trip is $ TBD (Read our 'Fund raising and tips pages.)

This includes all the following: Transportation, lodging, meals and construction materials.

Please fill out one application per person. An initial payment of $100.00 is due with the application and then around November 10^th. the cost of the airline ticket will be due. The balance is due by December 10, 2007.

Other expenses might include some of the following: Passport, discretionary spending money for souvenirs, and medical examination and vaccinations as recommended by your personal physician.

Please return to: Spartanburg Angels

205 Gantt Court

Duncan, SC 29334 USA

Name (legal name):______________________________________________

Name you go by: ________________________________________________

Birth Date: ______________________ Gender: Male ___ or Female___

Citizenship: ___________________________________________

Spanish Proficiency: Fluent ___, Moderate ___, Poor ___, None: ___.

Have you ever served on a mission trip before? If yes, where and when?

______________________________________________________

Home Address: _________________________________________

City: ________________________________ State: _____ Postal Code: _________

Email: ________________________________________________

Daytime Phone: ________________Evening Phone: __________________

Other Phone: __________________________________________

List Skills Relevant to Trip (Such as construction, carpentry, or medical):

_____________________________________________________________

Medical conditions, drug allergies, medications special food needs:

______________________________________________________

Do you swim? _____ Very well, _____

OK and comfortable in the water, _____

Not well, _____ Not at all _____.

Additional information: __________________________________________

___________________________________________________________________

T-shirt size: S ____, M ____, L ____, XL ____, 2XL, Other ____

Are you traveling with another person? Yes ____ No ____

If yes, who? ___________________________________________________

Room lodging/costs are based on two or more people per room. Different size beds in different rooms. Additional charge for single person in a room.

Notify in case of emergency: _______________________________________

Relation: ______________________________________________________

Phone: _______________________________________________________

Address: ______________________________________________________

2nd Person: ____________________________________________________

Relation: ______________________________________________________

Phone: _______________________________________________________

Address: ______________________________________________________

Why do you want to go on this mission trip to Honduras?

___________________________________________________________________