DR Mission Team Application 2021
INSTRUCTIONS:  This application is required for every member of the 2021 DR Mission Teams. It is vital information needed to secure plane tickets, organize teams, and keep everyone healthy and safe while in the DR. This application and your non-refundable payments are necessary to initially reserve your spot on the trip (please see http://drmissionteam.org/donate for all of the payment options and details).

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Please fill out the form below and hit submit. By submitting this form, you are verifying that all information is accurate and correct.

Questions? Please email john@drmissionteam.org or call 203-626-2239.
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First Name as it exactly appears on your passport *
Middle Name or initial as it exactly appears on your passport *
Last Name as it exactly appears on your passport *
Full Name as it exactly appears on your passport *
If you are applying for your passport, please list here the name you will use on your passport. This has to be exactly as it will appear on your passport as it will be used with the airline for your ticket.
Date of Birth *
Country of passport *
Passport expiration date *
Passport number *
Address *
Town *
State *
Zip Code *
Phone *
Email *
Gender *
Required
T-shirt size *
Required
Indicate your preferred week(s) in the DR: *
Required
Any notes related to your week(s) in the DR (if applicable):
Church Affiliation (if applicable)
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