South Dakota Mission Trip

*required
First Name*

Last Name*

Cell Number*

Email*

Birth Date*

Male of Female?*
MaleFemale
What college do you attend?

I understand that while on this trip, I will be representing Collegiate Impact and its affiliates. I agree to conduct myself with wisdom and consideration for others, respecting those in authority. “So as to walk in a manner worthy of the Lord, fully pleasing to him, bearing fruit in every good work.” Colossians 1:10
I agreeI do not agree
Do you have any food allergies?*

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