Mission Jamaica Statement of Intent

Mission Jamaica 2013 "I Want to Go"

No commitment is being made by the submission of this form. Submitting this Statement of Intent informs us of your interest in joining Lord of Life Lutheran Church on a 2013 Mission Jamaica trip.

Estimates MJ2013 costs will be available in July. Deposits are due in early September.

* Required

First and last name of person completing form *

Name(s) of family member(s) interested *

Email Address *

Home Address *

City *

State *

Zipcode/Postcode *

Best phone number to reach you at

I am interested in *
Week 1 - March 16-23 2013
Week 2 (Medical and Family Week) - March 23-30 2013
Both weeks

I am interested in the medical clinic.
Yes
No

Medical credentials (if any)