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FELLOWSHIP OF CHRISTIAN FARMERS INTERNATIONAL
Mission Trip Application Form
Please print and mail this form to the address shown on the form.
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NAME ____________________________________________________________________________________ (MINOR) - AGE ____________
ADDRESS ___________________________________________________________________________________________________________
CITY ____________________________________________________STATE/PROVINCE ______________ ZIP_________________________
COUNTY/PROVINCE OF BIRTH ________________________________HOME PHONE _____________________________________________
LANGUAGES SPOKEN/READ __________________________________ WORK PHONE______________________________________________
E-MAIL ADDRESS __________________________________ VOCAL ABILITY (SOLO, GROUP, CHOIR, etc) ____________________________
DATE OF LAST PHYSICAL ________________________________________ PRESENT HEALTH ____ GOOD ____ FAIR ____ POOR
DO YOU WEAR CONTACT LENSES? ____ YES ____ NO
DO YOU HAVE ANY HANDICAPS? ____ NO IF YES, EXPLAIN ___________________________________________________________________________________
ARE YOU PRESENTLY TAKING MEDICATION? ______ NO IF YES, EXPLAIN ________________________________________________________________________
OCCUPATIONAL EXPERIENCE: EXPLAIN HOW YOU FEEL YOUR SKILLS, HOBBIES AND PROFESSIONAL
TRAINING CAN BE BENEFICIAL ON AN OVERSEAS MISSION FIELD.
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OVERSEAS TRAVEL REQUIRES A PASSPORT. DO YOU HAVE A PASSPORT?
____ YES ____ NO PASSPORT # __________________________________ ISSUED WHERE ________________ WHEN ______________
LIST ALL PREVIOUS OVERSEAS FIELD EXPERIENCES BELOW:
FIELD PROJECT/CRUSADE DATE
_____________________________________________ __________________________________________________________ ______________________________
_____________________________________________ __________________________________________________________ ______________________________
_____________________________________________ __________________________________________________________ ______________________________
_____________________________________________ __________________________________________________________ ______________________________
CRUSADES FOR WHICH YOU ARE APPLYING:
____WORK CRUSADE ____AGRICULTURAL EVANGELISM CRUSADE ____SPECIAL CRUSADE "RAPID ACTION TEAM"
____BRAZIL ____RUSSIA ____HURRICANE RELIEF
____JAMACIA ____ALBANIA ____FLOOD RELIEF
____MEXICO ____UKRAINE ____HAYLIFT
____NICARAGUA ____ROMANIA ____TRUCKING
____PUERTO RICO ____TANZANIA ____TEXAS
TRIP DATE: FIRST CHOICE _________________________________________ SECOND CHOICE ________________________________________________
REFER TO SCHEDULE FOR AMOUNTS AND MAKE CHECK PAYABLE TO FCFI AND MAIL TO:
FELLOWSHIP OF CHRISTIAN FARMERS
PO BOX 15
LEXINGTON, IL 61753 PHONE/FAX (309) 365-8710
CHECK ALL THAT APPLY:
_____I AM INTERESTED IN SHARING MY CHRISTIAN FAITH WITH BUSINESSMEN AND PROFESSIONALS OVERSEAS.
_____I AM INTERESTED IN USING MY PROFESSIONAL SKILLS OVERSEAS.
_____I AM INTERESTED IN DONATING PROFESSIONAL EQUIPMENT, MATERIALS, OR SUPPLIES.
_____I WOULD LIKE TO BE ON YOUR MAILING LIST FOR THE 'PROFIT- NEWSLETTER.
_____I WOULD LIKE INFORMATIOM ABOUT FCFI CHAPTERS IN MY AREA.
_____I WOULD LIKE INFORMATION ABOUT STARTING A CHAPTER IN MY AREA.
_____I WOULD BE INTERESTED IN STARTING A WORSHIP SERVICE A T MY FARM GROUP MEETING.
_____I WOULD BE INTERESTED IN ASSISTING WITH A FCFI FARM SHOW BOOTH IN MY AREA.
_____I WOULD BE INTERESTED IN SHARING MY TESTIMONY IN THE "PROFIT".
EVANGELISM CRUSADE APPLICANTS ONLY:
STATE BRIEFLY WHY YOU WISH TO PARTICIPATE IN AN EVANGELISM CRUSADE:
__________________________________________________________________________________________________________________________________________
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HAVE YOU EVER LED ANOTHER PERSON TO CHRIST? ____NO ____YES
IF YES, USING WHAT METHOD(S): __________________________________________________________________________________________________________
DESCRIBE YOUR PRAYER AND BIBLE STUDY HABITS: ____________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________
Contract and Agreement
FOREIGN TRAVEL BY ITS VERY NATURE OFFERS AN UNFAMILIAR AND UNIQUE ENVIRONMENT, AND RISKS OF INJURY TO BOTH PERSONS AND PROPERTY ARE INHERENT. I UNDERSTAND THAT BYMYPARTICIPATION IN AN FCFI CRUSADE I AM INDICATING MY ACCEPTANCE OF THESE RISKS.
IN CONSIDERATI0N OF MY BEING ACCEPTED ON AN FCFI CRUSADE, I __________________________ HEREBY VOLUNTARILY RELEASE THE FELLOWSHIP OF CHRISTIAN FARMERS, INTERNATIONAL, INC. AND EACH OF ITS EMPLOYEES, TRUSTEES, OFFICERS, AND AGENTS OF THE NEGLIGENT OR OTHER ACTS OR OMISSIONS OF FCFI, ITS AGENTS OR EMPLOYEES.
I FURTHER AGREE TO INDEMNIFY FCFI AND EACH OF ITS EMPLOYEES, OFFICERS, AND AGENTS FOR ANY EXPENSES OR COSTS RESULTING FROM THESE ACTS OR OMISSIONS, OR RESULTING IN ANYWAY FROM MY PARTICIPATION IN AN FCFI CRUSADE, INCLUDING MY OWN NEGLIGENCE. I AM AWARE THAT BASIC ACCIDENT INSURANCE COVERAGE IS PROVIDED AS PART OF THE FCFI CRUSADE PROGRAM BUT THAT THIS INSURANCE MAY NOT COVERALL SITUATIONS.
FURTHERMORE, I UNDERSTAND THAT THERE IS NO PERSONAL PROPERTY INSURANCE PROVIDED THROUGH THE FCFI CRUSADE PROGRAM, AND THAT SUCH INSURANCE IS CONSIDERED A PERSONAL RESPONSIBILITY OF THE PROGRAM PARTICIPANT.
SIGNATURE: ____________________________________________________________________________________ DATE: _________________________________
IN CASE OF EMERGENCY, NOTIFY: NAME __________________________________________________________ PHONE:(________) ________________________
ADDRESS: ______________________________________________________________________________________________________________________________
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