Frontera de Cristo Application

U.S.-Mexico Border

Mission Delegation to U.S.-Mexico Border
November 11-17, 2023

You are invited to join Presbyterians from across Iowa on a mission delegation to the U.S.-Mexico border. This delegation is planned in partnership with Frontera de Cristo, one of five Presbyterian Borderlands Ministries.

We will worship with, learn from, and be in mutual mission with brothers and sisters in Lirio de los Valles Presbyterian Church in Agua Prieta, and experience life and ministry along the US-Mexico border.

Application

Please complete one form for each person. You will receive an email confirmation of your form’s successful submission. Applicants must have a valid passport that expires no sooner that 6 months after the conclusion of the trip. Applicants must be 18 years old or accompanied by a parent or guardian.

Lodging will be in dormitory rooms at Lirio de los Valles Presbyterian Church. The cost is $800 per person plus airfare. Partial scholarships are available.

For more information, please contact Mission Executive Amgad Beblawi at or 502-592-3223.

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Full Name:*

First Middle Last

Name you prefer to be called (If different than first name):

Address:*

Street Address City State ZIP Code

Cell Phone:*

Email:*

Home Church:*

Church City*

City

Presbytery:

What best describes you? Please check all that apply.*

Church Member

Ruling Elder

Deacon

Seminary Student

College Student

Teaching Elder

Other

Other:*

If you are not a member of a Presbyterian congregation, please provide two personal references.

I need to provide references.

References

If you are not a member of a Presbyterian congregation, please provide two personal references.

Reference #1 Name:

First Last

Relationship to you:

Number of Years Known:

Phone

Reference #2 Name:

First Last

Relationship to you:

Number of Years Known:

Phone

The activities of the delegation involve a moderate level of physical activity. Food will be mostly Mexican cuisine. Lodging will be in dormitory rooms at Lirio de los Valles Presbyterian Church in Agua Prieta, Mexico. Are you adaptable to simple accommodations?*

Yes

Do you have special concerns or needs of which we should be aware?*

Yes

If yes, please explain.*

The following question will help us get to know you as we prepare for this trip.

Write a brief biographical paragraph about yourself, your work, interests, family, and church involvement (to be shared with others on the trip).

PASSPORT INFORMATION

Please provide the following information exactly as it is recorded on your passport. Note that you must have a valid passport that expires no sooner that 6 months after the conclusion of the trip.

Hidden

Passport Number:*

Date Issued:*

MM slash DD slash YYYY

Expiration Date:*

MM slash DD slash YYYY

Gender:*

Male

Female

Please upload a copy of the page in your passport that includes your photo. Or, you can mail a photocopy to the presbytery office.

Max. file size: 15 MB.

HEALTH AND INSURANCE INFORMATION

All health and insurance information will be kept confidential and used only for the purposes of this trip. All questions in this section are required.

My general health is :*

Excellent

Good

Fair

Other

If other, please explain:

I have allergies:*

Yes

If yes, please explain:

I have physical restrictions:*

Yes

If yes, please explain:

I have dietary restrictions:*

Yes

If yes, please explain:

Are there any other special considerations we should know about?

Please explain.

Health Insurance Company:

Policy and Group Number:

Policy Holder's Name:

First Last

Insurance Authorization Phone Number:

I have been vaccinated against Covid-19.*

Vaccination may be required by host.

Yes

Date of First or Only Dose:*

MM slash DD slash YYYY

Date of Second or Most Recent Dose, if applicable.

MM slash DD slash YYYY

EMERGENCY CONTACT

Please identify a person whom we would contact in the event of an emergency while on the trip.

Emergency Contact Full Name:*

First Last

Emergency Contact Phone:*

Emergency Contact Email:*

Consent and Release

Consent*

Please read below before signing/submitting, as this constitutes an agreement between yourself and the Presbytery of North Central Iowa, the Presbytery of Prospect Hill, and the Presbytery of Des Moines regarding your participation in this trip:

I acknowledge and state that I have chosen to travel on this trip to Douglas, Arizona and Agua Prieta, Sonora, Mexico and their vicinity to participate in this mission delegation. I have chosen to sign up for and participate in this trip at my own risk.

I certify that I am physically able to participate in this trip. I assume all risk and responsibility as well as related costs and expenses for any damage or injury to my property or any personal injury, which I may sustain while on this trip. I understand that I am responsible for my personal effects and property while on the trip. I will hold them harmless in the event of theft, or for loss resulting from any source or cause. I further understand that I am to abide by whatever rules and regulations may be in effect for the accommodations at the time.

By my submitting this application, I release, discharge, indemnify and forever hold Presbytery of North Central Iowa, the Presbytery of Prospect Hill, the Presbytery of Des Moines, Frontera de Christo, and Lirio de los Valles Presbyterian Church and any other related agency, together with their officers, agents and employee, harmless from any and all causes of action arising from my participation in this trip, including travel or lodging associated therewith, or any damages which may be caused by their own negligence.

I have read and agree to this consent.

Date*

MM slash DD slash YYYY

Payment

A $100 deposit is required to save your space on the delegation. The total registration fee of $800 is due by October 1, 2023. If paying by credit card, 3% will be added to cover credit card fees. To pay by check, please make your check payable to United Presbyteries of the Plains and mail it to:
Presbytery Office
1864 Hwy 86
Milford, IA 51351

I am paying by:*

Check

Credit Card/PayPal

Payment Amount

Payment of Deposit - $100

Full Payment - $800

Credit Card Fee:

Price: $0.00

Credit Card Fee:

Price: $0.00

Total

Mission Delegation to U.S.-Mexico Border
November 11-17, 2023

Application

References

The following question will help us get to know you as we prepare for this trip.

PASSPORT INFORMATION

HEALTH AND INSURANCE INFORMATION

EMERGENCY CONTACT

Consent and Release

Payment

The Presbytery of North Central Iowa

Resources

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Mission Delegation to U.S.-Mexico Border ​November 11-17, 2023

Application

References

The following question will help us get to know you as we prepare for this trip.

PASSPORT INFORMATION

HEALTH AND INSURANCE INFORMATION

EMERGENCY CONTACT

Consent and Release

Payment

Mission Delegation to U.S.-Mexico Border
November 11-17, 2023