Name *
Name
Arrival Date - (Check-in: 3:00 PM)
Arrival Date - (Check-in: 3:00 PM)
Departure Date - (Check-out: 11:00 AM)
Departure Date - (Check-out: 11:00 AM)
Your Permanent Address
Your Permanent Address
To include Street Name/City/State/Zip Code
Phone
Phone
Emergency Contact Name
Emergency Contact Name
Emergency Contact Address
Emergency Contact Address
Emergency Contact Cell Number
Emergency Contact Cell Number
I understand, upon submission of this form, if I cannot fulfill this commitment, it is my responsibility to notify First Baptist Church of Lexington AS SOON AS POSSIBLE, so house can become available to other potential missionaries. $100 deposit will be REQUIRED to HOLD your reservation once confirmed. (This fee is waived for FBLex missionaries staying less than 1 week as part of a Mission Conference/Event/Reporting). Residents will be responsible to pay usage and upkeep fee of $20/day to help cover the cost of utilities. **Non-FBLex supported missionaries may have to provide additional information prior to confirmation of reservations.