Your Name

Your Address 

Your City State and Zip 

Your Alliance Church Name 

Are you the Pastor? 

Mission Trip Destination 

Mission Trip Dates 

Type  of Ministry (work, medical, etc.) 

Sponsoring Organization 

Approximate total trip cost 

Is your local church helping to fund? 

 How much is your personal contribution?  

Is this your first short-term mission trip? 

Acts 13:3 would teach us that the spiritual support of the local church’s leadership is vital when people are being released to start a missions ministry.  If you are a pastor, the support of your Governing Board is important.  If you are a lay person, the support of your pastor is critical.

Please ask the appropriate person to sign off below, and then send this application to Adriaan Overbeeke  at 147 Cooper Lane East, Cody, WY 82414

 If you are an unordained C&MA official worker, are you current on your ordination/consecration studies? Yes / No

     [If you are completing this form online, the person you name and/or your Pastor must email their endorsement of your trip to Adriaan Overbeeke at  adriaan@codycma.org

PLEASE NOTE:  Only 6 applications per church
are allowed per year.
 
**Board member name  

**YOUR ALLIANCE Pastor's name 
**REQUIRED INFORMATION