Spring Break Build Registration
Please fill out this registration form to join us for this semester’s Spring Break Build on Sunday, March 5th - Saturday, March 11th, 2023. After you register, you will receive an email with details regarding the tentative schedule, payment information, and suggested packing list.  

In order to participate in the trip, you will need a valid passport or passport card.  

If you DO NOT have a passport or if it has expired (or if it will expire within the next 6 months), you will need to apply for/ renew your passport online. Simply visit our Passport Guide (https://goo.gl/xCEBAU) for more information.  If you have a valid passport/passport card, you may continue with the application process below.

If you have any questions, please contact:

Liliana Reza, Director of Border Engagement 
lilianareza@pointloma.edu
619-849-2263
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Legal First Name: *
Preferred First Name:
Middle Initial:
Legal Last Name: *
PLNU ID: *
Email: *
Date of Birth: *please enter carefully* *
MM
/
DD
/
YYYY
Gender: *
ON-CAMPUS Participants - Dorm Number:
OFF-CAMPUS Participants - Address (including city, state, zip):
Cell Phone: *
Relationship to PLNU: *
Year (if a student):
Clear selection
Major (if a student):
Do you have a passport? *
If yes, expiration date:
MM
/
DD
/
YYYY
Passport Number:
Citizenship: *
(i.e. USA, Mexico, etc.)
Spanish Proficiency: *
Under Spanish proficiency the rating is from 1-5 with 5 being fluent in Spanish
Do you have any Ministry Experience?
(i.e. VBS, construction, painting, puppets, etc.)
Emergency Contact Information
Contact 1 Name: *
Contact 1 Cell: *
Contact 1 Email: *
Contact 2 Name: *
Contact 2 Cell: *
Contact 2 Email: *
Medical Information (for any of the following if none, list "NA")
Please describe any physical ailments/limitations we should know about for the trip:
Current Medications: *
Medical Conditions: *
Dietary Restrictions: *
Food/Medicine Allergies: *
Current Tetanus Shot: *
Health Insurance Provider: *
Plan/Group Number: *
Doctor's Name: *
Doctor's Phone: *
Have you participated with Ministry with Mexico in the past? *
Which Ministry with Mexico trips have you participated in previously? *
Required
What was most influential in prompting you to sign up for Spring Break Build?
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Would you like to be added to our monthly electronic newsletter, the Vamonos?: *
Additional Comments / Questions:
PROMO CODE:
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