2025 Bentonville Community Church Senegal Trip

Registration Options

Deposit ($200.00)
Half Payment ($1,700.00)
Full Payment ($3,400.00)

Payment Agreement

I understand that trip payments and release forms are due as follows:
$200 Deposit - due at registration (non-refundable)
$1700 1st Payment - due by August 1, 2025
$750 2nd Payment - due by September 1, 2025
$750 3rd Payment - due by October 1, 2025

ALL RELEASE FORMS ARE DUE BY OCTOBER 15, 2025

I have read and agree to the terms above.

Name

Date of Birth

Gender

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Female

Phone Number

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Address

Running Total

$0.00

Coupon Code

Total

$0.00

Passport Information

A passport is required for travel to Senegal. If you do not yet have a passport, please apply for one as soon as possible. Please enter your full legal name (first, middle, last) in the field below, and then fill in the rest with "N/A" until you receive your passport. If you have your passport, please double check for accuracy. GO cannot secure airfare or travel accommodations until we have all of this information.

Full Name as it appears on Passport

Passport Country of Issuance

Passport Number

Passport Expiration Date

Emergency Information

Medical Insurance Provider

Medical Insurance Policy #

Please list any food or drug allergies

Please list any medical conditions.

Emergency Contact Name

Emergency Contact Phone Number

Applicant Information

Have you been on any other mission trip? If so, where?

If yes, what were you doing? How did it shape your view of mission work?

What will be the most difficult part of preparing, going, and returning from this trip for you?

How long have you been a follower of Jesus?

Billing and Contact Information

Name

Credit Card

Visa
Mastercard
American Express
Discover

Address

Phone Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

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