Scotland Team Application

October 25 - November 5, 2019
Dundee, Scotland

Please list a few details for us here and we'll get back to you ASAP!

If you have any questions email Nikki at ncook@cccm.com

1Your Details > 2Commitment
Name as it appears on your passport Name as it appears on your passport First Middle Last
Sex *

Sex Male Female
Date of Birth Date of Birth * / MM / DD YYYY
Age *
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Cell Phone Cell Phone * - ### - ### ####
Email *
Emergency Info

In case of an emergency, who would you like us to contact?
Name Name * First Last
Relationship
Emergency Contact Phone Emergency Contact Phone * - ### - ### ####
Email *
Travel History
Do you have any physical concerns or limitations that might be a concern on this trip? If so, please describe: *
Are you currently taking any prescription medication? If so, please describe the medication and purpose: *
Have you been out of the country before?

Have you been out of the country before? Yes No
Have you ever been on a missions trip before?

Have you ever been on a missions trip before? Yes No
Do you have any concerns with traveling (air sickness, travel history)?

Do you have any concerns with traveling (air sickness, travel history)? Yes No
If yes, please explain
Do you have any dietary restrictions (including allergies) or preferences

Do you have any dietary restrictions (including allergies) or preferences Yes No

Scotland Team Application

Scotland Team Application

Emergency Info

Travel History