2012 S.L.A.M. TRIPS REGISTRATION FORM

Church/Organization Information

*(denotes required field)

Name: *

E-Mail Address: *

E-Mail Address again: *

Please enter your E-mail Address a second time.

Address: *

City: *

State *

Zip: *

Phone: *

Fax:

URL:

Group Leader Information

Name: *

Position: *

Address: *

City: *

State: *

Zip: *

H. Phone:

W. Phone: *

Group Information

Choose date of attendance: *

Gender Breakdown (enter a number for each):

Boys *

Girls *

Ages of Group (enter a number for each):

Under 12 *

12-15 *

16-18 *

Adults *

Mode of travel (number and type of vehicles) *

Please list physical skills of adults/students in your group (plumber, carpenter, electrician, drywall, etc.) *

Has your group taken a mission trip in the past five years? *

Yes
No

If yes, where?

Would you be willing to make a pre-trip visit before your group comes out? *

Yes
No

How did you hear about SLAM TRIPS? *

Website
Mail
Other

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