Lightnings of
God Ministries Int’l Inc.
Evangelism
Outreach Teams
Please enter the appropriate information in the following blanks provided below and return it to our office as soon as possible. This will help us process all the paperwork, concerning you, for this trip.
If you have a P.O. Box number, you will need to provide us with a street address. Your final packet with your tickets, passport, etc., will be sent to you by overnight express mail. The carriers will not deliver theses packages to a post office box.
If you have any questions, please contact our office/fax at (937) 275-9808.
PLEASE PRINT
Name (as you want to be called) _______________________________________________________________________
Date of Birth: ________________
Street Address ___________________________________________________________________________________
Telephone Numbers: Home (____)________________ Work (____)________________
Passport # ____________________ Expires ____________________
Name (exactly as it appears on your passport)____________________________________________________________
Country Issued: ____________________
Occupation: _______________________
Emergency Contact: Name: __________________________ Phone (Day): (____)_______________
Address: __________________________ Phone (Evening): (____)_____________
(City, State, Zip) __________________________________________________
Any disabilities? (List if applicable)
________________________________________________________________________________________________
________________________________________________________________________________________________
Name of current church you attend: ______________________________________________________________
Name of Pastor: _________________________________________________________________
Address: ___________________________ Phone: (____)______________
City: _____ State: _____ Zip: __________