Climb Kilimanjaro Application


Thank you for your interest in climbing Kilimanjaro with Africa Fire Mission.  Please complete the application below, submit your deposit and e-mail supporting documents.  We look forward to serving with you soon! Application deadline May 31, 2018

Application Form:

Date *
Date
Application Date
Home Address *
Home Address
Phone *
Phone
(best contact)
Date of Birth *
Date of Birth
if you don’t have a passport our need to update your passport, please begin the application process as soon as your application is accepted.
Passport Expiration Date
Passport Expiration Date
(*if your current expiration date is less than 6 months after the return date of the mission, please renew your passport)
You will be provided with 1 AFM long sleeve athletic shirt.
Emergency Contact Phone *
Emergency Contact Phone
Insurance Beneficiary Address *
Insurance Beneficiary Address
1 Reference name/relationship
*
1 Reference Phone
2 Reference name/relationship to you
*
2 Reference Phone
3 Reference name/relationship to you
*
3 Reference Phone
Agreements: Please check all of the following boxes to indicate your understanding & agreement. *

Pay your mission trip deposit here: