2016 GBBC - Chicago, IL

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* 1. Join Give Back Beyond Cincinnati as we travel to Chicago, Illinois to help the city! This year’s trip is scheduled for August 24 - 28, 2016 with a cost estimate of $250. Based on fundraising, this number may change. During the trip, we’ll work with the local Habitat for Humanity affiliate and other nonprofit affiliates to make a tangible impact in those communities. The team will be spending 2 days building homes, working from 7:30 am to 3:30 pm (approximately) and then spend the evenings and weekend relaxing, socializing and immersing ourselves in local culture. The cost of this trip will include:

1. Transportation to and from Chicago by van or bus
2. Housing (with a roommate)
3. Breakfast & lunch
4. Habitat for Humanity registration fee

A deposit of $150 is due by June 30, 2016. If you are unable to make this date and do not make alternative plans with the trip lead, you will be dropped from the trip.

By signing up, you are committing to your ability to fund the full amount of the trip and have time off work (as needed). As GBBC is a non-profit/volunteer organization, we encourage everyone to participate in the trip planning and preparation to make it the most successful one to date! By filling out this application, you acknowledge that you are:

(1) Interested and available on the dates listed above
(2) Able to pay the cost of the trip
(3) Physically able to handle hard labor and work every day
(4) Willing and able to take on an active role in planning and fundraising for the trip
(5) ……And have a great time on most of the most enjoyable weeks you will experience this year!

Have you read and agree to the aforementioned stipulations?

Yes

No

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* 2. Demographic information

Name:

Company:

Address:

City:

State:

ZIP:

Email Address:

Phone Number:

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* 3. Are you 21 years of age or older? (You must be 21 or older to go on this trip)

Yes

No

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* 4. Do you have time approved off work (school, etc.)?

Yes

No

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* 5. T-shirt size

S

M

L

XL

XXL

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* 6. Food allergies (Food restrictions or allergies we should be aware of as we plan lunches?)

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* 7. Emergency contact (Please provide us with the following emergency contact information:)

Name:

Relationship:

Phone number (primary):

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* 8. Are there any specific items to assist with trip planning you would like to make the GBBC - Chicago lead committee aware of? (Examples could include connections to people or businesses you know in the Chicago area, possibly you work for a company that would like to be a sponsor for this years trip, or you have a specific social evening event you would like to see planned during the week.)