England Immersion Travel Team Application - 2020 Please fill out the application below to be considered for the September 24-October 2, 2020, England Immersion Excursion to London, Birmingham, Manchester, and Sheffield, England. Bethany Helmkamp will be your trip coordinator. Kent Hunter and Tracee Swank will be your Church Doctor coaches during the trip and after you return home. The biography information will be shared with others attending the Immersion Excursion. All other information will remain personal and confidential and viewed only by Church Doctor Ministries staff. If you have any questions or have any trouble with this form, please call Bethany, 1.800.626.8515, or e-mail her at firstname.lastname@example.org. Bethany will contact you to pay online via PayPal or Quickbooks invoice. Application Date* Date Format: MM slash DD slash YYYY Name* First Last Nickname or preferred name?Email* Enter Email Confirm Email Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home PhonePersonal Cell PhonePassport Number*Passport Expiration Date* Date Format: MM slash DD slash YYYY Emergency Contact First Last Emergency Contact PhoneI would rate my passion for and commitment to revival in North America as:*123456789101 = lowest, 10 = highestI would express my willingness to pioneer extension work and my openness to use very different methods of "doing church" (not changing theology) as:*123456789101 = lowest, 10 = highestPlease list your dominant spiritual gifts.*Prior to the trip, you will be required to read several books and one report. Are you willing to do this?*YesNoWill you commit to pray that God will use you for revival, from now until we return from England?*YesNoNot SureYou will be encouraged to work on an extension ministry strategy for your church. Are you open and willing to consider the extension model, as it will be taught to you?*YesNoNot SurePriority will be given to those who visit England with a team of one, two, or three others. This is so you can process your experience together at home. Is this your intention?*YesNoNot SureIf you answered "YES" above, please list who will be on your team. Please be sure all of these individuals complete their own applications.Please add a short, 300 words or less, biography about yourself. This is used for the team "bio booklet" on the trip.*Are you willing to review with your team leader, a short, handwritten, strategic action plan showing how you will implement what you have learned?*YesNoAll participants must arrive in Manchester, England, by 5 p.m., September 24, 2020, without exception, unless you are hindered by a delayed flight. Are you willing to comply?*YesNoPlease list known food allergies.*Please list health issues and special requirements we should know. Information will be held in confidence by the immersion planning team and not be shared with others.*Special requirement could include a special plug for a c-pap machine.Please upload a profile picture of yourself.Accepted file types: jpj, png.Please email a profile picture to Bethany Helmkamp at Bethany@churchdoctor.org if you don't have it available now or have difficulty attaching it to this form.