Oklahoma Baptist Disaster Relief Response
Insurance Information
We cannot secure insurance without this information
Oklahoma Baptist Disaster Relief Response
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Insurance Information
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We cannot secure insurance without this information
Destination: ______________________________ Nature of work: ______________
Date of departure from home: ________________ Date of return: ______________
Team Leader: ______________________________ Cell phone: _________________
Name – list all team members
including team leader
Date of Birth
Beneficiary
Fax to Mary Stephens at 405/516-4941 or email to
mstephens@bgco.org
.
In order to be covered by insurance as you travel, send information before you leave.
Jan 2009
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