Church Planting International

Name:   Age:   Phone:

Address:   City:   State:   Zip:

E-mail address:


Have you been on a mission trip before? no yes

If so, where? When?


What does Jesus mean to you?


Please list any special talents you may have (fine arts, language, construction, leadership, etc.):



Pastoral Recommendation

Pastor's name:

Church's name:

Pastor's e-mail (required):