Please provide the following contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Cell Phone
Home Phone
FAX
E-mail
URL

Enter the date of your arrival

-- mm/dd/yy

Enter the time of your arrival

-- hour am/pm

Enter the date of your departure

-- mm/dd/yy

Enter the time of departure

-- hour am/pm

Select one of the following that apply:

Driving to Harlingen
Flying to Harlingen

If flying please give us the Airline, flight arrival # and flight departure #.

Total number coming

Please give us the total number coming. The number of Adults, youth and small children.

Choose one of the following options where your group will be working

Border Aldama Padilla

Please list anyone who will need special medical care or medicine along with their needs.

Please list anyone with special food needs and what those needs are.

What are you asking the Lord to do for your group during your missions trip?

Please list any special areas the group would like to minister in. Such as puppets, skits and etc.

Select any of the following options that apply:

Is the group interested in a construction project?
Are you interested in a day of shopping
Are you interested in going to the beach?

Do you have any specific things you would like us to pray for your group about.

Is there any special needs we need to be aware of?

Please give us any additional information that might assist us in planning for your group.

Choose one of the following options:

Docor or Medical Staff Pharmacists Carpenters Plumbers Electricians Heating & Air Painters Brick or Block Layers Tile Layers Advanced Computer Knowledge Spanish Speaking Musicians Farmers Mechanics