Trip Registration Form Today's Date:* MM slash DD slash YYYY Personal InformationName:* First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth:* MM slash DD slash YYYY Email:* Phone:*General InformationGive a brief overview of your relationship with Christ:*Have you used any alcohol in the past 12 months?*YesNoPlease explain frequency of use of alcohol.Have you used any drugs in the past 12 months?*YesNoPlease explain use of drugs.Have you used any tobacco in the past 12 months?*YesNoPlease explain type and frequency of use of tobacco.Do u have a criminal record?*NoYesIf answered yes to having a criminal record. Can you please explain?Trip InformationWhat trip are you signing up for?*St. Louis New YearsUgandaPeruNorthern IrelandHave you ever been on a T.O.R.N. mission trip before?*NoYesWhich T.O.R.N. Mission trip did you previously go on?Trip DepositsI understand that all trip deposits & donations are non refundable.* Yes, I Understand If you are not able to make the trip, your deposit will be donated to the ministry to help send others.Payment DetailsWhich trip do you need to leave a deposit for?*Peru S. (Lima) DepositUganda Trip DepositSt. Louis New YearsNorthern IrelandTotal $0.00 CAPTCHA