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IM Worker Travel Request Form
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For Workers traveling to the Mission Field.
Note: Complete and submit this form to International Ministries (IM) as soon as possible. IM will need as much time as possible to ensure that you can obtain reservations for your requested dates of travel.
Name
Assigned Country
Today’s Date
Please list all addresses and phone numbers of any residence from now to departure date.
Address
City
State
Zip Code
Date at this address
Phone
E-mail
Address
City
State
Zip Code
Date at this address
Phone
E-mail
(If you have more than two (2) residences from now until departure date, please list each address, date, phone and e-mail below.)
Additional Residences between Now and Departure
Passport and Visa Information
Complete the following information. Include all family members returning to field.
Name on Passport
Passort Exp. Date
Visa Exp. Date
Exit/Return Permit Exp. Date
Indicate Citizenship
US   CANADIAN
Name on Passport
Passort Exp. Date
Visa Exp. Date
Exit/Return Permit Exp. Date
Indicate Citizenship
US   CANADIAN
Name on Passport
Passort Exp. Date
Visa Exp. Date
Exit/Return Permit Exp. Date
Indicate Citizenship
US   CANADIAN
(If you have more than three (3) family members travelling, please list each person below. you will need to include passort/visa expiration dates, Exit/Return Permit expiration dates and citizenship.)
Additional Family Members Passport Information
What country(s) do you need visa(s) for
Note: Gabon–if you have had a carte de sejour in the past, you don’t need a visa.
Travel
Please arrange travel via most direct routing as follows. Note: All stopovers that exceed International Ministries travel allowance will be at personal expense.
Departure Date
Departure City
Arrival City
Stopover(s)
Date of
Stopover(s)
Date of
Stopover(s)
Date of
I have return tickets
YES  NO
(If yes, give specific information under comments: date of departure; departure city; airline and flight number for all connections; arrival city and time of arrival.)
Comments