Furlough Information Form

This information helps us better serve our missionaries while on furlough and when visiting our church.

Your Name*
First Middle Last
Email Address*
Phone Number
Please enter a contact number while you are in the US.
Family Members
Please enter the names of any family members who are traveling with you.
Field of Service or Ministry Name
Time of Service

For example, "10 years"
Your Missions Agency
- FBMI
If appicable
Furlough Dates
Please note: If you cannot give specific dates, please estimate and then explain in the comments section below. Thank you!
Date you started serving on the field*
MM slash DD slash YYYY
Date of arrival in the US
MM slash DD slash YYYY

If already in the US, please leave this field blank.
Date of return to the field
MM slash DD slash YYYY
Date arriving in Hammond area
MM slash DD slash YYYY

Please let us know when you will be in our area, if applicable.
Please select the most appropriate choice.
- I have already arranged to present at First Baptist.
- I would be interested in presenting at First Baptist.
- I would not be able to present at First Baptist.
Comments
Please include any other information you would like us to know. Thank you!

Furlough Dates