Alt Breaks 2014- Organic Farm in April

Participant Application for Alternative Break Trips

 
Please fill this out completely and submit. We will discuss next steps at the end of the application!
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1. Last Name
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2. First Name
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3. Nickname
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4. Permanent Address
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5. Phone #
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6. Birthdate
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7. Email Address (you are expected to regularly check it)
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8. Please list how you identify your gender (i.e., man, woman, trans*, etc.).
This may be helpful for us to know as we secure various lodging accommodations that may ask us to consider this information; if your site requires this, your site leader will open a conversation with your group and then create communication opportunities with individuals and the group before determining a plan. Our goal is always to secure lodging and host sites that offer inclusive facilities that welcome all.
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9. If you require accommodations to be able to fully participate in this trip, please list them below so we can plan accordingly (if none, please list none).
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10. Please confirm that you are applying for the correct trip by selecting the option below.
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