I, ___________________________ (print name) hereby avow that I personally will be traveling on the ______________________ (airline) ticket provided and that I am traveling expressly for missionary purposes and not for either business or leisure. (Heads of household can sign one form per family).
As a demostration of the validity of this affirmation, I am hereby furnishing the name and address of the sponsoring organization listed below.
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Organization Name: ______________________________________________
Organization Address: ________________________________________________
Organization City: ___________________________ State: _____ Zip: ____________
Organization Phone: ____________________ Fax: ________________________
The religious organizations non-profit Federal ID Number: _________________________
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Name of Traveller: (printed): _______________________________________________
Traveller Address: ________________________________________________
City: ___________________________ State: _____ Zip: ____________
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Signature: _________________________________________________
Date: _________________________________
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