Contact Pastor Steve Lortz at 406-652-3161 or slortz@myemmanuel.net for any mission trip questions.

Application for mission trips (if you prefer to print a copy and fill it in manually, click here: Mission Trip Application).

Name *

Gender *

Male

Female

Date of Birth: *

Enter in this format: ##/##/####

Address *

Country

City

State

Zip code

Phone *

Email *

CHURCH PARTICIPATION

Are you a member of Emmanuel Baptist Church? *

Yes

If no, are you an active regular attender?

Yes

If no, are you a member of another church?

Yes

What church?

Are you serving in a ministry of Emmanuel or another church? *

Yes

If yes, what ministry?

Have you completed Emmanuel's Confidential Disclosure Statement (background check)? *

Yes

EMERGENCY CONTACT INFORMATION

Name *

Relationship to applicant: *

Phone *

Secondary Phone *

ALLERGY / MEDICAL INFORMATION

Please list and explain.

Allergies: *

If none, write "none".

Medical Conditions or Limitations (include psychological or emotional): *

If none, write "none".

Dietary Restrictions: *

If none, write "none".

TRAVEL INFORMATION

Do you have a valid driver's license? *

Yes

Do you have a valid passport or passport card? *

Yes

Name on passport:

Enter the name EXACTLY as it appears on your passport.

Passport #:

Re-Enter passport #:

Expiration Date:

Personal Health Insurance Provider: *

If none, write "none".

Policy #: *

If none, write "none".

Primary Care Physician: *

If none, write "none".

Physician's Phone #: *

Do you have a criminal record? *

Yes

If yes, describe below.

SALVATION & CHURCH BACKGROUND

If you died today, are you confident you would go to Heaven? *

Yes

What do you base your confidence or assurance on? *

How long have you been a Christ follower? *

How confident are you in your ability to explain to someone how they can obtain eternal life? *

Very Confident

Confident

Fairly Sure

Could Use Some Help

Teach Me

TEAM PARTICIPATION

Have you been on previous mission trips? *

Yes

If yes, where?

Briefly discuss what Jesus Christ is currently doing in your life and why you desire to be part of a mission team. *

Do you have any questions or concerns?

Please list any skills, special abilities or gifting that may be helpful to the team, e.g. plumbing, carpentry, creative arts, technology, mechanical, etc. *

On which mission trip are you most interested in participating? *

CONFIRMATION

Planning is required for mission trips. Your commitment is crucial. Submission of the application does not guarantee a place on the team. Cost and financial deadlines will be provided when the teams are confirmed and travel arrangements are made.

I confirm that all information provided is true and accurate. *

Yes

Captcha *

reCAPTCHA is required.

Missions

2023-2024 Trips – We are currently working on mission trips using the Jerusalem, Judea, Samaria and to the ends of the earth mandate.