Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Emergency Contact Info (If under 18 it must be a Parent or Guardian) *

First Name

Last Name

Phone *

(###)

###

####

Please list two references (one church or ministry leader preferred) *

Reference 1

First Name

Last Name

Phone *

(###)

###

####

Name *

Reference 2

First Name

Last Name

Phone *

(###)

###

####

By signing this application, you are committing that:  1) The information you provided is true and accurate. 2) You will stay the entire time from check in check in on Sunday 6/22/2025, until we dismiss on Saturday 6/28/2025 after cleanup. Any extenuating circumstances require prior approval from CTW Leadership.   3) The full trip cost ($300) will be paid no later than May 1, 2025.  • Please note that Change the World Missions not only supports Madisonville, TX but also
 Missionaries all over the world. Please consider donating any extra amount that you can. We operate solely on donations and the leadership nor board members draw any amount of money from CTW but simply volunteer their time out of their love for the gospel of Christ. 4) You will be able to provide your own transportation to and from Madisonville, Tx. *

Checking the box is the electronic signature agreeing to the terms of your CTW 2025 application