REGISTRATION FORM - Love to the Nations

Name *

First

Middle

Last

Email *

Phone *

Instagram or FB URL

Gender *

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Roommate Options *

*There is an additional cost of $700 for a single room (without a roommate) which will be charged separately.

Preferred Roommate

If traveling with minors (13 and up) and desire a room for 3, please put both roommmates names.

Please tell us why you want to come on this mission trip *

SKILLS *

List any skills that you have that you feel could contribute to the team and the trip. (example: computer skills, construction, painting, creative, manual labor, singing, etc)

Terms and Conditions

By clicking submit, you accept the terms and conditions outlined above.

Dropdown Items *

Payment Info *

By Clicking Submit, you agree to Love to the Nations charging your card $500 for a non-refundable deposit. Your submission does not guarantee a place on the trip. Due to limited capacity, if trip is full, you will be informed and placed on a waiting list for the next trip. In this case, your $500 deposit will be refunded. Thank you for understanding.