Requested Departure Date *

MM

DD

YYYY

Requested Return Date *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone *

(###)

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Alternate Phone

(###)

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If registering a team for next calendar year, I understand that the exact pricing will be determined by January 1 of that year. *

I agree

I disagree

I further acknowledge that CSI Ministries is an Evangelical Christian Organization that believes that the Bible is the inspired Word of God, and that members on this team will abide by all rules and regulations found on the individual Team Member Consent Form. CSI Ministries reserves the right to decline any Team or individual applicant for any reason that is not in the best interest of CSI Ministries. *

I agree

I disagree

I acknowledge that I am responsible to make sure that the members of the team meet all application deadlines. 1) Within one week – $200 Registration Fee and Team Registration Agreement due to secure dates of travel; 2) 45 Days prior to departure – All applications must be submitted. 3) 30 Days Prior to departure– Final payment due to CSI Ministries; 4) 2 Weeks Prior to departure – Final flight itineraries due to CSI Ministries NOTE: The following deadline is for MEDICAL AND SURGICAL TEAMS ONLY: 6 Months Prior – Copy of Diploma, Copy of current medical license, 2 current passport-sized photos (not photo copies) due to CSI Ministries *

I agree

I disagree