Team Member Information Form "*" indicates required fields Step 1 of 3 33% Team Member InformationTeam Name*Select your teamHeritage Holden Dallas 2023Cornerstone Chicago 2023C3 Mexico 2023Emergence Kentucky 2023Pascack NYC 2023The Chapel Kentucky 2023Beacon Oswego 2023Beacon Kentucky 2023Living Word 2023Kingsbridge Guatemala 2023Metro Church 2023Beacon Mexico 2023Mt Bethel Ecuador 2023C3 Training Only 2023Full Legal Name*Enter your name as it appears on your birth certificate/passport. First Middle Last Suffix Preferred First Name*This is the name that will appear on your name tag. First Gender* Male Female T-Shirt Size*Adult SAdult MAdult LAdult XLAdult XXLBirthdate*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age on Trip*Since you are 18 or older, you need to complete a background check to go on your trip. If you have not yet authorized one, please take a minute to complete your Background Check Authorization. Contact InformationTouch the World primarily uses email to share important trip information and communicate with team members. Please provide email addresses that you check regularly. These email addresses will be added to Touch the World's email list.Personal Email* School Email* Cell Phone*Country of Citizenship* Mailing Address* Street Address 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 Please upload a picture of yourself*Choose a profile picture that clearly shows your face, such as a recent yearbook picture. Do not upload a group picture. We will use this photo to build your team roster.Accepted file types: jpg, png, tiff, pdf, heic, Max. file size: 60 MB. Passport InformationDo you have a valid passport?*A valid passport is one that will not expire for at least 6 months after your trip. If you need to apply for or renew your passport, click here to get started. Yep, I'm all set! No, I will apply for one or renew mine. Please note that it takes 6-8 weeks to obtain a valid passport. Start the process now to make sure you have your passport in time for your trip.Emergency InformationPrimary Emergency Contact Name* First Last Relationship* Mother Father Legal Guardian Other Primary Emergency Contact Mailing Address* Same as applicant mailing address Street Address 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 Primary Emergency Contact Email* Primary Emergency Contact Cell Phone*Primary Emergency Contact Work PhoneSecondary Emergency Contact Name* First Last Relationship* Mother Father Legal Guardian Other Secondary Emergency Contact Mailing Address* Same as applicant mailing address Street Address 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 Secondary Emergency Contact Email* Secondary Emergency Contact Cell Phone*Secondary Emergency Contact Work PhoneCommentsThis field is for validation purposes and should be left unchanged.
