Missionary Travel Association Online Registration Form For Mission Trips

1511 N Westshore Blvd, #650 Tampa FL 33607
Tel: (352) 678-5885 Fax: (352) 678-5848

INSTRUCTIONS FOR THE REGISTRAR:

Please note, if this is the first time registration for your [COI] Organization, Church or you as Individual (not registering as an organization or church), you will not have a [COI] ID number to enter. Please leave it blank. MTA’s database will assign a COI Number beginning with “C” and all new members will be assigned a member number beginning with “M”.

Please keep a record of ID numbers and enter the assigned ID numbers in future registrations. The database system will auto-populate the previously entered information.

Information for existing COIs cannot be changed using this form. Please contact MTA.

MEMBERS WITH A DIFFERENT DEPARTURE OR RETURN DATE MUST BE REGISTERED SEPARATELY

PRE-EXISTING MEDICAL CONDITION means an illness, disease, or other condition which member received a recommendation for a test, exam, or medical condition 60 days prior to trip. No coverage for such condition

Church/Organization /Individual ID Number: [example C132]:

Church/Organization /Individual Name:

Church/Organization /Individual Contact Person:

Church/Organization /Individual Street Address:

Church/Organization /Individual City:

Church/Organization /Individual State:

Church/Organization /Individual Zip:

Church/Organization /Individual Country:

Church/Organization /Individual Phone & Email

Registrar Name & Email

MTA PROVIDES NO ENROLLMENT OPTIONS FOR:
Afghanistan, Belarus, Burkina Faso, Central South Republic, Chad, Gaza/West Bank, Haiti, Iran, Iraq, Israel, Lebanon, Libia, Madagascar, Mali, Myanmar, Niger, Nigeria, North Korea, Russia, Somalia, South Sudan, Sudan, Syria, Ukraine, Venezuela, Yeman.

Mission Type:

Team Name:

Team Leader [Going on the Mission trip]:

Team Contact Phone & Email:

Destination City:

Destination Country:

Travel Start Date:

Travel End Date:

MTA Invoices are to be paid by Credit Card only.
ID cards will be sent when payment is received.

Your invoice will be sent to the email of the COI Contact Person and the Registrar

INSTRUCTIONS: All MEMBERS TRAVELING MUST BE ENTERED BELOW

1. If you do not have a member number beginning with an “M” please leave the ID # blank

2. When inserting a member number and the member name and date of birth showing is not yours, please delete the wrong member number, enter your information and continue with the registration process

3. Previous registered members personal information is blocked from being seen for security purposes

4. Information for existing users cannot be updated using this form. Please contact MTA.

5. OPTIONAL Cancellation and Interruption coverage benefit can be added for $4.00 [four] per travel day.
Example: a 3-day mission trip will be an $12 additional cost; a 9-day mission will be an $36 additional cost.

6. USA DOMESTIC MISSION TRIPS includes all benefits except a member's personal medical insurance and any other insurance is primary.

7. ALL MEMBERS REGISTERED MUST BE A U.S.A. LEGAL RESIDENT.

8. MTA benefits are not available for any trip participant who turns 81 or higher on the day of trip departure.

Member #1

ID #

First Name:

Middle Name:

Last Name:

Birthdate:

Passport #

Beneficiary

Optional Cancellation & Interruption coverage Cost

If this is your first registration MTA would appreciate answering how did you hear about MTA?

Referral by

Internet

Other:

I confirm that this registration is for a MISSIONARY TRIP ONLY and is not for pleasure, a vacation or tour.

Your invoice will be sent to the email of the COI Contact Person and the Registrar

To view the specific MTA Travel Protection Plan Documents for your State prior to purchase please click here: Your Benefits — Missionary Travel Association

Missionary Travel Association

AH-3551