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Batam, Indonesia Missions
Personal Information
Salutation 称呼
Select One
Assoc Prof 副教授
Dr 博士
Mdm 女士
Mr 先生
Mrs 太太
Ms 小姐
Prof 教授
Ps 牧师
Surname 英文姓氏
Given Name 英文名字
Gender 性别
Male 男
Female 女
Mobile 手机号码
Email 电邮
Church 教会
Lighthouse Evangelism
Others
NAME as per PASSPORT
Passport Number
Passport Date of Issue
Passport Date of Expiry
Date of Birth
Are you currently in a cell group in LE?
Select one
YES, I am in a cell group
NO, I am not in a cell group
Name of Cell Group Leader
Cell Group Join Date (mm/yyyy)
Which LE Centre do you worshipped in?
LE Tampines (LET)
LE Woodlands (LEW)
Ministry Currently Serving In
Food Allergy
Twin-sharing roommate preference, if any (State Name/relationship)
Ever participated in overseas missions? If yes, which countries?
Person to Contact in Case of Emergency （Full name & Contact No.)
Indemnity - I assume and accept all risks and to be solely responsible for any injury, loss or damage, arising out of my participation in this mission program and all related activities.
Yes, I confirm
Indemnity - I shall hold harmless, indemnify and release Lighthouse Evangelism, their employees and their representatives from any and all liability for any damage to the personal property of, or personal injury to, any third party and all claims, demands, actions and costs which might arise out of my participation in this mission program and all related activities.
Yes, I confirm
Indemnity - I confirm I will purchase my own travel insurance (including Covid-related cover) for this Missions trip.
Yes, I confirm
Indemnity - I will diligently observe and fully comply with all safety instructions given by the committee. In the event that I do not co-operate with the committee, the committee reserves the right to send me home at my expense.
Yes, I confirm
Indemnity - In the event that you are unable to travel due to whatsoever reason(s) after the issuance of air ticket, the travel agent will make arrangement with the airline to make the necessary cancellation charges and refund. The amount of refund can only be defined upon issuance of air ticket. The committee will seek the participant’s confirmation of trip prior to issuance of air ticket.
Yes, I confirm
Submit
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