Please provide the following contact information:

Date of Application:   Mo./ Day/ Year 

Full Name: 

Address:            Street, City, State, Zip, Country 

Telephone:                                             Fax:
             

E-mail: 

Date Accommodation Desired:    Arrival Date/ Date of Departure 

Present Status:  (You must be with an established evangelical mission or Christian organization.) Foreign or Home missionary in a regular or medical furlough or equivalent. Approved missionary appointee on deputation or equivalent. Other Christian worker with evangelical, established Christian organization. Retiring missionary who has just completed life-time missionary service (within one year of retirement date). Retired missionary or Christian worker (Space available basis only).

Have you been our guest/s before:  If yes, when? 

Field and years of service: 

When did you arrive from the field? / When do you plan to return?  

Mission Agency / Christian Organization:

Name & Address:           Street, City, State, Zip, Country

Telephone:            Fax: 

E-mail:                 Agency Website: 

Contact person:         Position: 

Telephone:  (If different from above) 

Names & Dates of Birth for ALL THOSE APPLYING:

Single:     

Husband: 

Wife:        

Children:

Emergency Contact in U.S.A.

Name: 

Address:   Street, City, State

Telephone:          E-mail: 

Permanent Mailing Address (if different from above):

Name: 

Address:   Street, City, State, Zip, Country

Telephone:            Fax: 

E-mail:  

EDUCATION:  Bible School, College, Seminary, Other:  (Please give dates, major, etc.)

Do you have any specialized skills?  (Construction, nursing, music, etc.)

Home church and Pastor's name:

Address:    Street, City, State, Zip, Country

Telephone:             Fax: 

E-mail: 

Give a brief account of your conversion/s (for each adult):

Give a brief resume of your ministry experience (for each adult):

AGREEMENT:  Please read and sign:
We understand that for stays of one week or more, each family unit will work a minimum of 5 hours per week and singles will work 3 hours per week. There will be a charge of $8.00 for each hour not worked. We have carefully read the Policies, Procedures (available from D&D), and Statement of Belief and Practice of D&D Missionary Homes, and we agree to willingly and conscientiously accept them and will abide by them. We understand that no pets are allowed. Note: This application will not result in a confirmed reservation until your application has been reviewed and approved and an Administrative Fee of $100.00 (U.S. funds) has been received by D&D. *The $100 Administrative fee is not applicable to stays of less than 1 week.

Applicant Signature & Date:     Spouse Signature & Date:   (Your typed signature will serve as your personal signature.)