EmailMe Form - 2022 Summer Outreach Registration Form

한글 성명 *

Write N/A if English name only

Date of Birth (MM/DD/YYYY) *

Name (English)
*Should be the same as Passport Name *

Email *

Phone *

### - ### - ####

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Mother's Name
(Turkey Visa Purposes) *

First Last

Father's Name
(Turkey Visa Purposes) *

First Last

Community *

성인 공동체

EM

Holy Impact

SHINE

SBS Season 5 Teacher *

Yes

No

Country (성인 & EM) *

Palestine - $1,000

Dominican Republic - $xxx

Country (Holy Impact SBS Teachers) *

$150

Country (SHINE) *

Palestine - $1,000

Dominican Republic - $xxx

Country (SHINE
SBS Teachers) *

Palestine - $1,000

Dominican Republic - $xxx

$150

회비 결제 방법 *

Cash

Credit Card

Passport Copy *