Welcome to Encounter Group

How did you hear about Encounter Group? *


Your Encounter Group Representative. (if applicable)


Director Information
Name *
Email *

Church / Organization Information
Church/Organization *
Address *

City *
State *
Zip Code *
Phone *
Mobile Phone
Fax
Email *

Mission Project - Choose an Encounter. (Check all that apply) *
	Dominican Republic	Peru
	Cuba	Latin Medical
	Vanuatu	Ghana
	Island Medical	African Medical
	Mazatlan

Mission Project - Choose options you want to integrate into your trip. (Check all that apply) *
	Church Construction	Childrens Crusade
	House Construction	Sports Clinic
	Community Service	Medical Clinic
	Music Ministry	Cleaning and Painting
	Church Repair	Youth Crusade
	House Repair	Athletic Events

Select your trip date: *


Give the # most likely to be the FINAL COUNT (please use a conservative number and read our cancellation policy)
Adults *
Youth *

Comments: Please include any comments, or questions that you would like for us to address.
NOTE: This electronic registration form is for reservation only. Your registration will not be complete until we recieve the $200.00 registration fee and other required release forms. Once this form is completed and submitted, you will be given a username and password to access these forms.