S.E.A. APPLICATION FORM

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First and Middle Name*

Last Name*

Student ID Number*

Email*

Gender

Male

Female

Marital Status

Single

Married

Do you have a Passport expiring after Dec 2015?

Yes

No

Country of Choice

Brasil $1300

Colombia $800

Mexico $600

Wherever God needs me

Cell Phone Number

Where do you live on Campus? Please Select Talge Thatcher Southern Village Off Campus

Home Address*

Church Membership Please Select Alaska Conference Alberta Conference Allegheny East Conference Allegheny West Conference Arizona Conference Arkansas-Louisiana Conference Bermuda Conference British Columbia Conference Carolina Conference Central California Conference Central States Conference (AAC) Chesapeake Conference Columbia Union Conference Dakota Conference Florida Conference Georgia-Cumberland Conference Greater New York Conference Gulf States Conference Hawaii Conference Idaho Conference Illinois Conference Indiana Conference Iowa-Missouri Conference Kansas-Nebraska Conference Kentucky-Tennessee Conference Lake Region Conference (AAC) Lake Union Conference Manitoba-Saskatchewan Conference Maritime Conference Michigan Conference Minnesota Conference Montana Conference Mountain View Conference Nevada-Utah Conference New Jersey Conference New York Conference Northeastern Conference Northern California Conference Northern New England Conference Ohio Conference Oklahoma Conference Ontario Conference Oregon Conference Pennsylvania Conference Potomac Conference Quebec Conference Rocky Mountain Conference South Atlantic Conference (AAC) South Central Conference (AAC) Southeastern California Conference Southeastern Conference (AAC) Southern California Conference Southern New England Conference Southwest Region Conference (AAC) Texas Conference Texico Conference Upper Columbia Conference Washington Conference Wisconsin Conference Outside North America

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