Title (Mr. Mrs. Miss): ________________________________________________Date of Birth: ________________

Name:________________________________________________________________________________________

Address: ______________________________________________________________________________________

______________________________________________________________________________________________

_____________________________Postcode:____________________Phone: _______________________________

Occupation / Studying: ___________________________________________________________________________

I am a member of (Church): _______________________________________________________________________

Team Applied for: _______________________________________________________________________________

Dates (From-To): _______________________________________________________________________________

Do you have any health or dietary problems? __________________________________________________________

Please give details: _______________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

Passport Number:________________________________________________________________________________

Which (if any) musical instrument do you play? ________________________________________________________

Which languages do you speak? ____________________________________________________________________

PERSONAL DECLARATION:
After prayerful consideration, I apply to join the GLO team as indicated.
Signed: ______________________________________________________ Date: ____________________________

FOR COMPLETION BY CHURCH ELDER/SECRETARY:
On behalf of the local church I am happy to commend the above named person to be involved in a GLO Short Term Mission.
Name:________________________________________________________________________________________

Address: ______________________________________________________________________________________

______________________________________________________________________________________________

_________________________________________________________Postcode:_____________________________

Phone:________________________________________________________________________________________

Signed:_______________________________________________________________Date:____________________