Form

Liberty Trip Application
Destination
Date of Trip
Personal Information
Full Name
First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number
- Area Code Phone Number
E-mail
Employer
Birth Date
Month Day Year
Gender

Male Female
Marital Status

Single Married Seperated Divorced
Passport Number
Issue Date
/ Month / Day Year
Expiration Date
/ Month / Day Year
Have You Been on Trip with Liberty Before

Yes No
If yes, When/Where
Emergency Contact and Travel Insurance Information
Emergency Contact Full Name
First Name Last Name
Relationship to You

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number
- Area Code Phone Number
Mobile Number
- Area Code Phone Number
Describe Your Health

Excellent Good Average Poor
Describe any health or physical limitation that could affect your service.
Are you current taking any medications? If so please list them here.
References

Please Provide Two
Reference 1
Phone Number
- Area Code Phone Number
E-mail
Reference 2
Phone Number
- Area Code Phone Number
E-mail
Church Background and Salvation
Please share a bit about your salvation experience
I attend Liberty

Not at all 1 time a month 2 times a month 3-4 Times a month
If you do not attend Liberty where do you attend?
Could you please share some ministries you are currently involved with?
How do you plan to pay for this trip?

Pay it all my self Raise Support Raise support and pay some myself
What We Believe
The following represents the beliefs of Liberty and the Missions Ministry. If you agree check the last box that says "Agree with All" If there are any exceptions, list those below. Exceptions do not necessarily mean you will not be able to go with Liberty on this trip.

We Believe that Jesus Christ was born of a virgin. We believe in the literal resurection of Jesus. We believe in a literal heaven and hell. We beleive the bible is without error in its original form. We believe that when a person repents from sin and turns to faith to Christ , they are saved by grace. We believe that a Christian receives the Holy Spirit when he is saved. We believe that the Father, Son and the Holy Spirit are 3 persons but one God. We believe in the physical return of Christ. We believe in the deity of Christ and His substitutionary attonment. We believe in the priesthood of the believer, that all Christians have direct access to God through God. We believe that man was created by God. We beleive that a person cannot lose thier salvation. We believe in miracles and the supernatural workings of God. I agree with all the docitrinal statements above.
I have read the doctrinal statements of Liberty and am in agreement with all except the following exceptions ( If Any) .
Date form submitted
/ Month / Day Year
A deposit of $100 is required to make this application active. You can give that to the missions associate or you can drop it in the missions drop box in front of the Mission Center.
Should be Empty:

Liberty Trip Application

Personal Information

Emergency Contact and Travel Insurance Information

References

Church Background and Salvation

What We Believe