Application Form – Outreach to Northern Territory

INFLUENTIAL MISSIONS AND OUTREACH PROGRAMS INC.

APPLICATION FORM

I wish to be part of the outreach to an Aboriginal community in the Northern Territory Outback of Australia.

GENERAL INFORMATION:

Name:
Address:
E-mail:
Phone:
-
Age:
Male or Female:
Date of Birth
Marital Status:

SPIRITUAL INFORMATION:

What is the name of your home church?
Name of your pastor:
Phone Number:
Mobile Number:
Have your participated in any Mission Trips?
If yes. When?
Where?
What ministries are you involved with at your church?

Please give two references of people who know you and your spiritual walk.

Reference1 Name:
Reference 1 Phone:
-
Reference 2 Name:
Reference 2 Phone:
-
Why are you interested in participating in this outreach?
What are your expectations?
What are some of the gifts you feel you would bring to this outreach? What are your skills that might be useful?

HEALTH INFORMATION:

Do you have or have you ever had:
If yes to any of the above, please explain:
Do you have any condition which might affect your ability to fully function as a Missionary on this outreach? (Motion Sickness, Depresssion, Anxiety, Sleeping Disorders)
If yes, please explain:
Are your presently under medication perscribed by a doctor?
If yes please explain:
How would you describe your overall health?

EMERGENCY CONTACT NUMBERS:

Name (1):
Relationship to you (1):
Address (1):
Phone (1):
-
Name (2):
Address (2):
Phone (2):
-

DECLARATION:

Influential Missions & Outreach Programs Inc.  and the organiser of this outreach requires strict compliance with rules and regulations, including the rules concerning conduct, dress and Christian lifestyle.

Team members serve at their own risk, and Influential Missions & Outreach Programs Inc. is not liable in the event of sickness, accident, death or for transportation and any other expense beyond normal involvement.  We require all participants to be in good physical condition.

I have read and understand the above information.  The information I have given is accurate and true to the best of my knowledge.

Name as signature of Applicant
Date of Application:
Word Verification: