Thank you for your reservation request!

Now, please complete your Haiti Mission Trip Registration:

*First Name

*Last Name

*Email

*Phone

*Address

*City

*State

*Zip

*Date of Birth (mm-dd-yy format)

*Gender

*Church

Team Leader

Role at church, if any:

Have you been on a short-term mission trip before? If so, list location:

How did you hear about this ministry?

Do you have a trade or skill that you would like to contribute during your trip?

Additional Message