Mission Volunteer Interest Form

Thank you for your interest in missions. We would love to assist you as you seek an open door for mission service. Please complete the volunteer form below. We will provide information regarding volunteer mission opportunities as they become available. Those who are younger than 18 may only volunteer as a member of a family group, church volunteer team, or as a part of a BGCM approved team. Please call us for any additional ways we can serve you as you seek volunteer mission opportunities.

Contact Information:

* Required fields

First Name:*
Last Name:*
Address 1:
Address 2:
City:
State:	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip:
Home Phone:*	Area Code: Prefix: Number:
Day Phone:*	Area Code: Prefix: Number:
Cell Phone:	Area Code: Prefix: Number:
Fax:	Area Code: Prefix: Number:
Email:
Date of Birth:	January February March April May June July August September October November December   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908
Marital Status:	Single Married Divorced Widowed
Spouse First Name:
Spouse Last Name:

Background Information:

Mission Service:

Trip Dates:   -

I have participated on a volunteer mission trip   Stateside   Internationally

I have worked with peoples of cultures other than my own   List:

I am reading about the culture and I am preparing to serve cross-culturally before I leave

Education:

College Degree   Degree/Major:

Life Skills:

Employment:

Yes No   Employed

Employer:     Position:

Church History:

Yes No   Attend Church

Church Name: Address 1: Address 2: City: State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip: Pastor: Denomination:

ESL Certification:

Certified: Yes No   Year of Certification

Volunteer Commitment:

Finally, by checking the box below, I hereby express my understanding that the BGCM and its associates do not assume any responsibility for loss of property, damage to the same, personal harm or illness that may come; and I, for myself, my heirs, my executors, administrators, distributes and assigns, in consideration of my admission to volunteer service and other good and valuable considerations, do hereby absolve said BGCM and its associates and hold them harmless from any claim or demand which I or they might conceivably assert upon the basis of the foregoing.

Yes, I have read and fully understand the paragraph above.

Some opportunities will require a background check.

If you would like documentation of your volunteer service with BGCM for tax purposes, please let us know. This will be done on an individual basis and by request only.

Please send documentation of my volunteer service

Is your health and physical condition sufficient for the assignment for which you are volunteering? Yes No

All international volunteers are required to enroll and show proof of Voluntary Missionary Travel Insurance.

All national volunteers are required to show proof of personal health insurance.

Thank you! Please make sure you have filled out the form completely.

Again, please call or email us with any questions or concerns.

BGCM Volunteer Missions Office-Columbia

Please return to: BGCM, Attn: Volunteer Missions 1900 N Providence, Suite 301 Columbia, MO 65202 Phone: (573)441-2574 (888) 420-2426 (toll free) Fax: (573)874-9222 Email: BGCM@baptistgcm.org

SUBMIT

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