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House Rebuilding Camp 2008-Registration

Home Rebuilding Application
Section I: General Information
Information:

Cost of the program: $1,200 (not including flight). This cost includes $600 that will be used for building material for the project.

Dates: July 31st-August 14th.
First Name *
Middle Name
Last Name *
[Note: Please type your full name, above, exactly as it appears on your passport]

Home Phone Number *
Mobile Phone Number
Work Phone Number
E-mail Address *

Mailing Address:

Street Address *
City *
State (U.S. Only)
Zip Code *
Country *

 
What is the best way to contact you? *


Passport Information

Citizenship *
Place of Passport Issue *
Passport Number *
Issue Date *      
Expiration Date *      

 

Date of Birth *      
Gender *
What is your ethnicity?
How did you first hear about the trip?
Would you like to receive our periodic mailings? *
Would you like to receive our e-mail newsletter? *
Emergency Contact Information *
Do you have any allergies? *
If so, please list:
Are you a vegetarian? *
Special Needs
Have you traveled to the Middle East before?
If so, where and why?
Is there someone else participating in the program who you would like to be housed with? If so, write their name here:
Are you married? *
Is your spouse or partner also participating in this trip? *
Do you have any children attending? *