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. .. .. .. .. .. ..		Footsteps Educational Trip Please fill out this application as completely as possible. Name (as it appears on passport) Address Home Phone Number Work Phone Number FAX Number E-mail Address Trip Information: Please select the trip for which you are interested Journeys of the Bible-Redeemer Lutheran (September/October 2006) Journeys of the Bible-Footsteps (September/October 2006) Other (See Below) If other, please specify country and month of trip: Personal Information: Age Birthdate Gender (Please Select One) Male Female Citizenship Passport Number Expiration Date If you do not have a passport, you find information about getting one and print out the necessary forms from the US State Department. Marital Status (Please Select One) Single Married Roommate Request Occupation Church Membership (optional) Health & Insurance Information: Insurance Carrier (include appropriate group numbers, insurance phone number, etc.) Insurance Carrier's Phone Number Emergency Contact and Phone Number Please describe any health limitations that may require supervision Do you require any medication? If so, which types and for what condition/s. If you are wondering about the immunizations and vaccinations recommended for travel, the Center for Disease Control has information for every country in the world.
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