Hope Encounter Application

I am applying to serve with MOHI at this location:

Grand-Goave, Haïti Luperón, Dominican Republic

Name

This address will receive a confirmation email

Home Phone

Mobile Phone

Address

Birth Date

Sex

male female

Passport Number

Issuing Country

Passport Expires

We recommend uploading a JPG or PDF copy of your passport in case of loss during trip

Upload (8MB)

Home Church

Your Pastor's Name

Name of Emergency Contact

Emergency Contact Phone

Emergency Contact Email

Name of Team Leader

Team Arrival Date

Team Departure Date

Please list any restrictions (physical limitations, allergies) you may have and medicines you are currently taking. (If none, please indicate such.)

Respond here:

Skills I possess and will offer as service to MOHI

Additional Pertinent Information

Please follow this link to read and sign the Participant Agreement.

A $100 deposit is required to complete the application process. This deposit will be used toward preparations for your arrival and is non-refundable.

Nonrefundable deposit

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Join a Hope Encounter - a week of serving the Lord and the people of Hispaniola (Haiti and the Dominican Republic) with Mission of Hope International. Complete this form to begin your journey today.

Hope Encounter Application

Description

Please Fix the Following