Michigan Congregational Churches

New Orleans Gulf Coast Recovery Mission Project

February 22 to 26, 2016
APPLICATION (as of 12/5/15 at 10 am ET there is a still problem with this
form...if you encounter an error message, please try again in 24 hours
and/or send an
email to lys2@semaccmission.com
)

Please fill in the information below and click Submit.

In order for your application to be complete, you must also send a non-refundable $35
deposit check (add $11 if you want a new 2016 t-shirt, for a total of $46), made out to
SEMACC, to:

Ken Swartz
c/o North Congregational Church
36520 W. 12 Mile Road
Farmington Hills, MI  48331
Name:
Street Address:
City, State and Zip Code:
Home Phone:
Cell Phone:
Email address:
Home Church:
I need a ride to New Orleans:
I am at least 18 years old:
I will be flying to New
Orleans:
We can use my car/van to
drive to New Orleans:
I would like a new 2016
t-shirt (include $11 with your
deposit check):
I am willing to help drive any
vehicle:
I am renting a car and I am
willing to drive others from
the airport and/or to and
from work:
T-Shirt Size: