GRAYMERE MISSION TRIP REGISTRATION

Name (Please add your name as it appears on the U.S.-issued identification with which you will travel) *

*If your identification lists a middle name, include it in the box for First Name. **If you are awaiting arrival a passport, register under the name you put on the passport application.

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Passport Issue Date:

MM

DD

YYYY

Passport Expiration Date:

MM

DD

YYYY

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

(###)

###

####

(Minors Only) Parent Phone Number

(###)

###

####

Service Opportunities

Please select all areas in which you would feel comfortable serving.

Teach Adult Bible Class

Teach Youth Bible Class

Teach Children's Bible Class

Lead Men's Training Class

Lead Women's Training Class

Preach

Lead a Short Team Devotional

Lead Singing

Lead Prayer

Serve Communion

Evangelism Team Leader

Evangelism Assistant

Driver

Construction Work Team

Benevolence Team

Cooking Team

Registration Fee *

$100 non-refundable fee is due with this registration, and will be applied toward your trip costs. Checks may be made payable to: Graymere Church of Christ, and sent to: Attn: Jonathan Winchester, Graymere Church of Christ, 1320 Trotwood Avenue, Columbia, TN 38401. Additionally, you may also mark it for "Missions" and submit online via the giving platform located at www.graymere.com

I Agree

I Disagree

Trip Arrangements *

All arrangements and reservations will be made by Graymere, and you will be expected to reimburse the church prior to the mission trip.

I Agree

I Disagree

Acceptance of Financial Responsibility *

Submission of this registration will indicate your intention to participate, and will cause expenses to be incurred on your behalf. If, for some unforeseen reason, you decide to back out of the trip, you will still be responsible for the expenses already incurred. Do you accept the financial responsibilities associated with your participation in this mission trip?

I Accept

I Do Not Accept