Please provide the following contact information for your VIM team mission request.

Sponsor Church Name: ___________________________________

Address:  ______________________________________________

Pastor Name and Phone:  _________________________________

Contact Person Name:  ___________________________________

Phone Number:   ________________________________________

Email Address:  _________________________________________

Approximate Group Size:

     Youth (Ages 13-17)______________________________

     Adults: ________________________________________

     Total Team:_____________________________________

(Please confirm the number on your team one month prior to your arrival date)

Amount of Deposit Included:  ______________________

I have reviewed and agree to the terms of the fee schedule.


Signed: _______________________________________   Date: _______________________