Mission:180 Wales Application Section A Name: __________________________________________   Date of Birth: _________________ Address: __________________________________________  City: ______________________ State: ___________  Zip: ____________    Phone Number: ______________________________   Email Address: ____________________________________  T-shirt Size:  S   M   L   XL   XXL Church Name: _______________________________  City: _______________  State: ________ Section B Please rank the following activities as how comfortable you would be doing them.  1 is Very Uncomfortable and 5 is Very Comfortable. _____  Preaching                _____  Balloon Animals        _____  Drama        _____ Witnessing          _____     Music         _____  Recreation               _____  Refreshments            _____ Crafts          _____ Prayer walking     _____    Puppets Section C                                                            Please circle Do you have a U.S. Passport?                            Yes                No Have you been a Christian for at least 1 year?        Yes                No Are you a member of a church?                           Yes                No Section D    If you have previous Mission:180 International experience you may skip this step. Please write a brief essay (not more than two typed or three hand written pages combined) on each of the following questions.   -1 How and when did you become a Christian? -Why do you want to do Mission:180? Section E Please list two references who know you well, but are not family members. ___________________________________     ____________________________ Name                                                                   Phone ___________________________________     ____________________________ Name                                                                  Phone Thank you for completing this application.  Please mail it to: 180 Degree Ministries   12506 Old Shelbyville Rd.  Apt. 2  Louisville KY  40243