Montana Mission Trip Registration
Please fill out this form and click submit.
June 23 - July 1
Sign-Up Deadline:
April 30th
Name
*
Phone
*
Email
*
This address will receive a confirmation email
Spouse's name
Number of adults participating
*
Number of children participating
*
Participating children's names and ages
Will you be riding the bus?
*
Please select one option.
Yes
No
Do you hold a CDL license, and if so, would you be willing to drive?
Please select one option.
Yes
No
TWO emergency contacts are required.
NAME - Contact #1
*
PHONE - Contact #1
*
NAME - Contact #2
*
PHONE - Contact #2
*
Cost:
$150 per person with a $600 cap/family. A $50 deposit per person is due now ($200 cap/family), and the remaining balance is due by June 23rd. Deposits are non-refundable (exceptions made for emergencies only).
DEPOSIT
1 person ($50)
2 people ($100)
3 people ($150)
4 people (cap/family) ($200)
1 person ($50)
2 people ($100)
3 people ($150)
4 people (cap/family) ($200)
Amount
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
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