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MISSIONARY SERVICE FELLOWSHIP, INC.
128 Pleasant Site Road
Selmer, TN 38375
E-mail:Fredrickson@Bigfoot.com
For Office Use:
Arrive________________
Depart_______________
Application for Reservation for
Selah Cottage
Name: _______________________________________________________ Date: ____________
(Last) (husband) (wife)
Correspondence Address: _________________________________________________________
________________________________________________________ Phone: (___)___________
Date Reservation Desired: (Please list more than one choice if possible - Mo./Day/Year
1st Choice : Arrive __________________ Depart _____________________
2nd Choice: Arrive __________________ Depart _____________________
3rd Choice: Arrive __________________ Depart _____________________
Present Status: Active ________ Retired ________ On Deputation ________
Field of Service: _________________________________________ Years of Service: __________
When arrive from field? ______________________ When plan to return? ____________________
Mission Board: ________________________________________ Years of Service: ____________
Address: __________________________________________________________________
Home Church: ________________________________________ Pastor: ____________________
Address: ___________________________________________________________________
Names and relationships of those who will come to Selah Cottage:
Husband:_______________________________________ Birth date: ________________
Wife: _______________________________________ Birth date: ________________
Children: _______________________________________ Birth date: ________________
_______________________________________ Birth date: ________________
_______________________________________ Birth date: ________________
_______________________________________ Birth date: ________________
_______________________________________ Birth date: ________________
_______________________________________ Birth date: ________________
Give name, address, phone no. Of who to contact in an emergency:
_____________________________________________________________________________
_____________________________________________________ Phone: (___)_____________
Please enclose a photo or prayer card. Send your prayer requests and letters through the years so
we can pray more effectively for you.
How did you learn of Selah Cottage? _________________________________________________
Please give us your e-mail address: ___________________________________________________
Please give a brief resume of your field activities on back of this page.
