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ABOUT YOU

Your Information

For this section, please provide your name as it appears in your passport as well as provide the best contact information we can connect with you. NOTE: You will have to upload a scan or photo of your passport in a later section.

First Name *

Last Name *

Middle Name (if applicable)

Nickname (if applicable)

Birthdate * +

Gender *

Street Address *

Address Line 2

City *

State/Province/Region *

Zip/Postal Code *

Country *

Phone Number *

Phone Number Type *

Email Address *

Do you speak Spanish? *

Yes

No

What ministry gifts do you operate in? *

Do you have media capture skills (i.e. videos, photos, social media, etc.)? *

Yes

No

Emergency Contact Information

Please provide the following information for your emergency contact. The most reliable contact information will help expedite communications in case of any emergency.

First Name *

Last Name *

Relationship *

Phone Number *

Email Address *

Preferred Departure + Passport Upload

Are you flying out from the US? *

Yes

No

Are you interested in flying with the group from the US? *

Yes

No

Preferred Airport or Departure City *

Alternate Airport or Departure City

A digital upload of your passport is necessary to reserve your spot as part of the ministry team in Mexico 2024. Please ensure the following before uploading a scan or photo of your passport:

Your passport is VALID AND NOT EXPIRED. If it is expired, please renew it by following the appropriate processes in your country. Also, please let us know by connecting with us at info@harvestim.org so that we can provide instructions for you to complete the application.
The file uploaded must display all necessary information clearly to avoid delays in getting the best deal available for this ministry trip.

Upload Scan or Photo of Passport Here *

Passport Country of Issue *

Important Health Information

For your safety and to prepare for necessary accommodations during this ministry trip, please answer the questions below to the best of your knowledge.

Do you have any allergies? *

Yes

No

Please list any and all allergies along with necessary medications (if known) *

Do you have any medical conditions? *

Yes

No

Please list any and all medical conditions along with necessary medications (if known) *

Do you have any disabilities? *

Yes

No

Please list any and all disabilities along with any accommodations to be requested (if known) *