Name *
You must fall into one of the following categories to participate in a trip through PBC
Address *
Phone *
Birthday *
Spouse's Name
Spouse's Name
If applicable
If applicable
Please list all involvement
Please list/describe any cross-cultural experience
Please list
The following questions only pertain to people applying to physically go on a short-term trip. The informations disclosed below will be held with confidentiality by those involved with planning global mission at PBC. Answering yes to any of the following questions is not an automatic disqualification from participation. If you answer yes to any of the following, please provide an explanation.
In an effort to make global mission accessible to every member of PBC, we want to provide avenues for financial support. There is no guarantee that financial support will be provided but the following information will help us determine which members get support at what level. If you checked the "Go" box above and are able to fully fund your trip then please skip this section. If you are partnering with a team and able to provide financial assistance, please check the last box and someone will contact you for further information.
Financial Factors
Check all that apply
PBC may purchase travel insurance on your behalf. Please list your beneficiary for this purpose below
Beneficiary *
Full Name *
Full Name
Exactly as it appears on your passport. You can include your first and middle name in the First Name box below.
Issue Date *
Issue Date
Expiration Date *
Expiration Date
In submitting this application...
Please check all