X hits on this document

PDF document

Florida Annual Conference United Methodist Church - page 1 / 3

6 views

0 shares

0 downloads

0 comments

1 / 3

Florida Annual Conference United Methodist Church

2007 Department for Ministry Protection

Church Trip Form

IMPORTANT: This form must be completed and submitted at least ten (10) days prior to departure for all motor vehicle trips over 500 miles round trip within the United States. All drivers must be 21 years of age or older, hold a Florida Drivers License and have at least one year of U.S. driving experience to operate

a church vehicle.

Church Information (all fields required):

Church Name:

City

District:

GCFA#:

Contact Person:

Title:

Phone Number:

(

)

Fax:

(

)

Email:

Trip Information:

Departure Date:

Return Date:

Destination(s):

Purpose of Trip:

Estimated Round Trip Miles:

Number of Passengers:

Adults:

Youths:

Total:

Vehicle Information:

Vehicle Registered to: Vehicle Identification Number:

(required for church owned vehicles only)

Year:

Make:

Model:

Continued on Second Page

Administered by: Arthur J. Gallagher Risk Management Services Arthur J. Gallagher & Co. (Florida) 2255 Glades Road Suite 400 E Boca Raton, FL 33431 Phone: (800) 282-8011 ext. 126 Fax: (561) 892-3982 Additional information and all forms are available on the Florida Conference website (www.flumc.org) Revision Date: 12/18/2006

Document info
Document views6
Page views6
Page last viewedFri Dec 02 22:44:26 UTC 2016
Pages3
Paragraphs94
Words795

Comments