AWSOM Team Application- Confidential

AWSOM Team Application

Australian Wesleyans Serving Overseas Missions
GENERAL INFORMATION
Full PASSPORT Name (this is used for your booking and must match)

First NameMiddle NameLast Name
Date of Birth

DayMonthYear
Birthplace
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Phone/Mobile Number
Format: 0000000000.
Name of Emergency Contact

First NameLast Name
Address of Emergency Contact

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone/Mobile Number of Emergency Contact
Format: 0000-000-000.
Which AWSOM trip are you wishing to be part of?
Do you have any medical condition or allergies which may hinder your ministry overseas?
If YES please detail here.
Are you taking medications regularly
If YES please detail here.
Do you use any of the following?
If so please detail.
Due to local custom/expectation abstinence may be required during the time of the trip.
Marital status

Other

REFERENCES - Please provide the details of two referees whom we can send a reference form to.
Your Pastors name

First NameLast Name
E-mail
Mobile Number
Format: 0000-000-000.
Phone Number
Format: 00-0000-0000.
2nd Reference Name

First NameLast Name
E-mail
Mobile Number
Format: 0000-000-000.
Phone Number
Format: 00-0000-0000.

PREPARATION
Do you understand that you are responsible for all personal costs other than what is included in a ‘packaged’ AWSOM trip?
Do you have a valid Australian passport? (MUST have minimum 6 months validity from the date of RETURN of your trip.)
Passport Number
Passport Expiry date

DayMonthYear
Date
IF YOUR PASSPORT IS NOT VALID FOR AT LEAST SIX MONTHS AFTER THE RETURN DATE OF YOUR TRIP PLEASE MAKE APPLICATION FOR A NEW PASSPORT BEFORE COMPLETING YOUR APPLICATION.
Medicare Number
Citizenship details
A non-refundable application fee of $20 will be required so that your application can be processed.

To make your payment via direct deposit here are the details:

Wesleyan World Missions
BSB: 034083
Acc#: 950962
Ref: Surname/AWSOM
I understand that my $20 application fee will be non-refundable
Signature

Use your computer mouse or touch screen to sign your name before submitting.
Wesleyan World Missions, 519 Mt Petrie Rd. Mackenzie, QLD 4156

wwm@wwm.org.au 0424223333
Click here for the Reference Form, to forward to two referees, Thanks.
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