Jack Myers Ministries Missions Application
Your Full Name
Mailing Address 1
Mailing Address 2
Home Phone Number
Cell Phone
Email Address
City
State:
Zip
Country
Information About Your Church or Congregation Affiliation
Name of Church/Congregation
Denominational
Affiliation
Mailing Address 1
Mailing Address 2
City
State:
Zip
Country
Senior Pastor
Church/Congregation Phone
Information About Your Missions Experience
Have you ever been on a missions trip out of the country?
 Yes No
Do you have a
current passport?
 Yes No
Are you a medical or healthcare professional? If so, please indicate your area of expertise:
Physician (indicate specialization area)
Nurse ( RN / LPN)
 Dentist
 Orthodontist
 Other (Indicate here )
Are you a licensed or ordained minister?
 Yes No
Licensing or ordaining organization:
Why would you like to participate on a missions trip with Jack Myers Ministries?
What are you
interested
in doing?
Helps Ministry  
If you will be participating as part of a group, what is the name of your group?
 Medical
 Dance / Drama
 Evangelism
 Intercession
How do you plan to fund your expenses on a missions trip?
Once we receive your completed Application we will contact you to confirm your desire to participate with us. At that time you will be asked to provide the following:
  • Please Read Introductory Letter it has some important information you need to know.
  • Completed Application
  • Letter of recommendation from your Pastor.
  • Three personal letters of reference.
  • Medical Release Form
  • Fee Deposit

Completion and submission of this form does not imply that you have or will be accepted as a team member on any tour or missions trip with Jack Myers Ministries. An invitation to participate is solely at the discretion of Jack Myers Ministries. You are responsible for your own travel expenses, tour fees and miscellaneous personal expenses. Participation is restricted to persons 17 years or older, unless accompanied by a parent or legal guardian. Space is limited and available on "first come, first served" basis.
Click this button only once. If you have problems getting this form to work, please print it and fax to 708-283-2326.