AWSOM Team Application- Confidential

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*
Phone Number
2nd Reference Name*

First NameLast Name
E-mail*
Mobile Number*
Phone Number

PREPARATION
Do you understand that you are responsible for all personal costs other than what is included in a ‘packaged’ AWSOM trip?

YESNO
Do you have a valid Australian passport? (MUST have minimum 6 months validity from the date of RETURN of your trip.)

YESNO
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*

YESNO
Signature*

Clear
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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