Date of Birth *

MM

DD

YYYY

Phone *

(###)

###

####

Sex *

Female

Male

Gender *

As stated on passport or passport application

M

F

X

Do you have a current and valid passport? *

If expired or expiring within 6 months of March 2025 answer no.

Yes

No

I understand that on this trip I will represent my school, my country, and Wisconsin Christian Campus Ministries (hereafter WCCM). I agree to conduct myself at all times in a way that honors those entities. *

Yes

No

Are you aware of any warrants or any other Local, State, Federal, or International restrictions that would prevent you from traveling outside the U.S. or entering any country in the European Union? *

Yes

No

I understand that there is inherent risk involved in an international trip of this nature and will assume all risk related to participating in this trip releasing Wisconsin Christian Campus Ministries from all liability. *

Yes

No