We welcome your interest in going to Uganda with ACTI! Please provide the information below, which we need to make your trip as fulfilling, efficient and safe as we can make it. Please submit this to your Team Leader, or e-mail it to: sutherlandj@utc.campus.mci.net or fax it to 423-822-1091
First name_______________________________
Last name_____________________________ID#(office use)______
Employer/School____________________________________
Mr. Miss Mrs. Other_______Nationality________________
1st foreign mission trip? Yes__ No__
Best address_________________________________________________
City__________________________________State_____Postal code___________
Work phone___________________________Work extension_________
Home phone________________________
Mobile Phone______________________Fax Number_____________________
Email name___________________________________
Referred by_________________________
Marital status____________Spouse’s name_________________Date of birth_____
Desired ministry activities, in order of preference___________________________________
____________________________________________________
Home church_____________________________
Home pastor______________________
Pastor’s telephone___________________________________
Pastor’s mailing Address___________________________________________________________
Pastor’s fax______________________Pastor’s email_______________________________
Team leader____________________________Expected departure date____________
Return date_____________
Closest major airport—departure_____________________Closest major airport—return_____________________
Airline_______________________
Flight number going________Flight number returning_________
Passport #____________________Expiration date___________(Please provide photocopy of page with photo.)
Are you willing to work with Christians from a wide variety of other denominations? Yes__ No__
Why do you want to go to Uganda?_________________________________
_________________________________________________________________________
___________________________________________________________________
Are you willing to complete a brief post-trip evaluation form? Yes__ No__
Are you willing to thank all known donors and give a report to them upon your return? Yes__ No__