Name - First & Last
Mailing Address (Street, City, State, ZIP)
Will you have any dietary needs? If yes, explain.
Will you have any allergies? If yes, explain.
Emergency Contact Name
Relation to you
Emergency Phone Number
Have you ever traveled out of the country? If yes, where?
What would you hope to gain from this experience?
It is our goal to provide experiences for all volunteers that will further their professional/personal life goals. Please share how trip leadership and Haitian staff could help you reach these goals.
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