2012 SCC GO Team Application Form


Dear Potential Global Outreach Team Member,

We are so excited that you want to join a GO Team this year!
No matter what team the Lord has called you to join, it will be a life changing opportunity that you will never forget.
He has so much in store for you.

         
         
[*LEGAL name: We use this version of your name to book your flight tickets. It must match the version you use/ will use on your passport exactly.]        
     
Legal Name:

[First]

[Middle]

[Last]

  First Name Required Middle Name Required Last Name Required  
     

Goes by Name:

Please use letters only

     
Applying for Trip to: Please select a trip Dates:

:

  
     
Drivers License # Please enter a valid license # State: Please select a state    
     
Passport Number: Please enter a valid passport # Expiration Date: Invalid Input    
     
Age: Please enter a valid age Birth Date: Invalid Input Place of Birth: Invalid Input
     
Street Address:       City:             State:     Zip Code: 
 Please enter your address      
Email Address:  
  Please enter a valid Email    
Phone Numbers:  Cell/Primary: Please give a valid phone number in xxx-xxx-xxxx format. Other/Secondary: Please give a valid phone number in xxx-xxx-xxxx format.
       
Parent’s name: Invalid Input      
         
Marital Status: Spouse’s Name: Invalid Input  
   Please select (S)ingle (M)arried or (D)ivorced      
Are you a committed follower of Jesus Christ? Member of SCC?   Primary   campus:
       Invalid Input
Please select Yes or No  Please select your member status
         
Shirt Size & Style:                 
   Invalid Input                 Please select a size    Please select style
Two Personal References: [can be anyone]    
         
Name: Name of reference Relationship: Relationship type Phone: Please give a valid phone number in xxx-xxx-xxxx format.
         
Name: Name of reference Relationship: Relationship type Phone: Please give a valid phone number in xxx-xxx-xxxx format.
         
Medical Informaion:    
         
Medical Insurance:
Policy #:
         
Family Doctor:
Phone:
         Please give a valid phone number in xxx-xxx-xxxx format
List any known medical conditions, physical limitations, prescriptions and/or allergies:  
 
 
 
         
Emergency Contact :  
Relationship:
   Please enter your emergency contact name      Relationship type
Emergency Phone: (Very Important)    
   Please give a valid phone number in xxx-xxx-xxxx format.      
         
         
      Notice: Unless you receive a confirmation email your form was not submitted properly.

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Have a Blessed Day!