England 2023 Immersion Application | Church Doctor Ministries

Application Date*

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 Country

Home Phone

Personal Cell Phone

Passport Number*

Passport Expiration Date*

I would rate my passion for and commitment to revival in North America as:*

1 = lowest, 10 = highest

I would express my willingness to pioneer extension work and my openness to use very different methods of "doing church" (not changing theology) as:*

1 = lowest, 10 = highest

Please 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?*

Yes
No

Will you commit to pray that God will use you for revival, from now until we return from England?*

Yes
No
Not Sure

You 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?*

Yes
No
Not Sure

Priority 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?*

Yes
No
Not Sure

If 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 "biography 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?*

Yes
No

All participants must arrive in Manchester, England, by 5 p.m., April 13, 2023, without exception, unless you are hindered by a delayed flight. Are you willing to comply?*

Yes
No

Please list known food allergies.*

Please list any preexisting health conditions or special requirements that would be important for Tracee to know about while traveling. (You may submit this under a confidential direct email to Tracee, tracee@churchdoctor.org)*

Special requirement could include a special plug for a CPAP machine.

I understand all trip fees paid to Church Doctor Ministries are nonrefundable. If I am unable to participate in the trip for any reason, I may find a replacement traveler from my church or attend a future England Immersion trip. Replacement travelers must complete the application and be approved by Church Doctor Ministries. I understand these fees do not cover vaccines, testing, or any costs associated with quarantine or medical care needed during my travel. (initial below)

Emergency Contact Name

First Last

Emergency Contact Relationship

Emergency Contact Phone

Emergency Contact Email

Emergency Contact Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please upload a profile picture of yourself.

Accepted file types: jpg, png, Max. file size: 256 MB.

Please email a profile picture to Nicki Tackett at nicki@churchdoctor.org if you don't have it available now or have difficulty attaching it to this form.

England Immersion Travel Team Application - 2023

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