GENERAL INFORMATION

Name:
(As it appears on your passport. Please include middle name)

Name:
(As you desire it to appear on your name tag)

Address:
(Please no P.O. Boxes)

City: State: Zip:
Home Phone:  Work Phone:
E-mail: Fax:

Gender: Male Female
Marital Status: Single Married Widowed
Occupation:
Company:

Name:
Passport #: Citizenship: Exp. Date:

Full Package (incl. flight)
Land package (w/o flight)

MEDICAL INFORMATION
(Please bring prescription medicine inside your carry on luggage on the plan)

Medical Carrier: Account #
Does your carrier include international travel? Yes No
Are you under medical supervision at this time? Yes No
If you answered yes, please describe fully in detail


Are you currently taking any medication? Yes No
If so what kand?

CHURCH AND GROUP INFORMATION

Fill out the following as they apply to your church or group:
Traveling alone? Yes No
Church Name:
Group (Where from)?
Name of Team Leader:
Are you traveling with any family members? Yes No

Name:
Relationship:

Name:
Relationship:

Name:
Relationship:

Name:
Relationship:

If we are able to pair you with a room mate, please list your top three (3) choices. Please note next to the person's name if they are or not part of your group.

Choice #1:
Choice #2:
Choice #3:

MINISTRY HISTORY

Are you in full time ministry? Yes No
If yes, please explain:


How did you hear about REVIVAL MINISTRIES INTERNATIONAL?
Have you ever been on a REVIVAL MINISTRIES INTERNATIONAL missions trip? Yes No
Which one?
Have you ever attended any other RMI functions? Yes No

PRAYER SUPPORT

List three intercessors that you will have in prayer for you before, during, and after the mission.

Name:
E-mail Address:
Fax#:

Name:
E-mail Address:
Fax#:

Name:
E-mail Address:
Fax#:

PERSONAL TESTIMONY

Please type a one page essay of your testimony. We would like the essay to include the following items:

1.  Describe your "conversion" experience with Jesus. Or, how did you become a Christian?


2.  Has anyone in your past ever put you in contact with the Occult or a cult group?


3.  Describe your present spiritual relationship with the Lord.


4.  Are you actively involved in your church? How?


5.  Rate your personal beliefs/experiences in the Kingdom of God: 1=Charismatic through 5= Conservative. Where do you consider yourself on this scale?

6.  Where do you see your self heading according to God's will for you?


MINISTRY INFORMATION

Give as much detail as possible

My African dialect speaking ability is:
 Fluent (from stage)
 Conversational/Per son to person
Basic
None

I believe my spiritual gifts include:

Intercession
 Prophecy/Exhortation
 Preaching/Teaching
 Evangelist/Missionary
Service /Helps
Giving
 Leadership
Healing/Miracles/Faith
Administration
Deliverance
Pastor

TALENTS AND GIFTS

 Drama
Music
Puppets
Worship
Sports
Performance
Dance
Band
[macro overflow] Ensemble
[macro overflow] Soloist
[macro overflow] Mime
[macro overflow] Prayer Evangelism
[macro overflow] African Soloist
[macro overflow] Other

Check one of the following instruments that you play:

[macro overflow] Guitar [macro overflow] Bass [macro overflow] Drums [macro overflow] Keyboard [macro overflow] Brass
[macro overflow] Other: [macro overflow]
Are you bringing your instrument? [macro overflow] Yes [macro overflow] No

What is your passion for ministry (if you could do anything, what would you do?)
[macro overflow]

Have you ever shared your testimony in puiblic? [macro overflow] Yes [macro overflow] No

Have you ever preached a sermon? [macro overflow] Yes [macro overflow] No 
If so, where? [macro overflow]
to whom ? [macro overflow]