Evangelist Ethan LeCroy

Mission Trip Registration Form

Please use the form below to register.

Note that there is a required digital signature at the bottom of the form. If you do not complete the required information on all five pages and digitally sign it, the registration will not be made. When the registration is completed, you will get a confirmation message (and be redirected to the payments page) as well as receive a confirmation email. If you are not redirected to the payments page, the registration is not completed.

You will need a passport to go on the trip as well. If you don’t have a passport, you can find information on getting a passport here (note that it takes 8-11 weeks to get a passport (5-6 weeks if expedited) so please plan accordingly).

 If you have any questions or experience any issues, or if you are unsure if the registration was successful, please contact us at registration@evangelistethanlecroy.com and we will be happy to help.

    ---------- PERSONAL INFORMATION ----------

    Name (as it appears on your passport) *
      Contact Information * State: Gender * MaleFemale

    ---------- EMERGENCY INFORMATION ----------

    In Case of Emergency Notify: *
     
      Phone Number(s) *
     
      Are there any medical restrictions or disabilities that we should know about? * Yes_Restrictions_or_DisabilitiesNo_Restrictions_or_Disabilities Are there any known allergies to Medications, foods, insect bites, etc.? Yes_AllergiesNo_Allergies If you have known allergies, Have you ever experienced an allergic reaction which required emergency medical care? Yes_Allergic_ReactionNo_Allergic_Reaction

    ---------- REFERENCES ----------

    Are you a member of a local church? * YesNo How did you hear about this trip? * At my churchFrom a friendevangelistethanlecroy.com website

    ---------- PASSPORT ----------

    Do you have a valid passport? * YesNo How I will provide my passport * UploadMail ---If Uploading: Upload a copy of the passport declaration page (the page with your picture). ---If Mailing: Please make a copy of your passport declaration page (the one with your picture), and mail it to the following address. Please note your trip number and travel dates on the back of the copy.   Missions Initiative Trips (MIT) New Life Baptist Church 1405 Simpson Road Odenville, AL 35120

    ---------- LIABILITY WAIVER ----------

    Are you under 18 years of age? *

    Yes_Under_18No_Not_Under_18 Liability Waiver
    Signature of traveler (or parent/guarding if traveler is under 18) *
    (use mouse or finger to sign)

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