NICARAGUA MISSION TRIP Passport expiration date:_________ APPLICATION To enter Nicaragua, you must have 6 months left before it expires!
Which mission trip do you wish to go on? _________________(MONTH)
PRINT LEGAL NAME: EXACTLY as it appears, or will appear, on your passport
street address
city	state		zip code
home phone  ( )	*email address* (print clearly please)
t-shirt size: S M L XL XXL XXXL	First name or nickname I want on my name tag:
If this is your first time on a trip with us, how did you hear about us?
Name of your home airport you wish to fly out of:
Health problems/allergies that we should know about?
occupation:		date of last tetanus booster:
birth date:		marital status:
If married, spouse name:		daytime phone of spouse:
If not married, emergency contact person: relationship to this person:		daytime phone of contact: evening phone of contact:
Where will you be getting the funds for this trip? Paying myself Church paying
SIGNATURE of applicant (under age 18 requires additional page & signatures) DATE X

For more information, visit our website: www.nicefoundation.org

Make checks payable to: NiCE Foundation $300 deposit required with this application.

Mail to: NiCE Foundation, 108 Bayridge Court, Glen Carbon, IL 62034

Email: billbeltz@hotmail.com PHONE: 618/288-6078 FAX: 618/288-6304