This form is completely confidential and will only be seen by our team and certified Le Rucher debriefers involved in the retreat planning.

First Name *

Last Name *

Date of birth *

Gender *

Marital Status *

Nationality

Phone (with country code) *

Email *

Preferred Contact Method:

Current Role/Ministry Focus

How many years and months have you served on the field? *

What has been the length of your stay on the field for this term? *

Other than ‘someone recommended it,’ why do you feel debriefing would be helpful for you at this time? *

Is this your first Exchange at the Cross debriefing? *

If No, when and where was your previous debriefing?

Are you currently under the care of a licensed psychologist or psychiatrist? *

If yes, please share what kind of care you are receiving.

Which retreat dates interest you? (check all that apply)

January 26-30, 2026 (4 spaces available)

April 12-17, 2026 (8 spaces available)

Are you applying for a single or couple debrief? *

Spouse Name

Please indicate the church or congregation that serves as your sending organization.

Retreat Cost: $800 individual / $1,300 couple

Please choose which payment option works best for you *

If you selected financial assistance or a custom payment plan, please briefly describe your situation so we can work together to find the best solution.

In case of an emergency, who should we contact in your organization or church? *

We’d Love to Stay in Touch – Tell Us What You’d Like to Receive! *

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I agree that the information I share with Compass Asia is confidential and will only be shared with the Compass Asia team and the debriefer(s) directly involved in my care, unless required by law.

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