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GB Exchange Indiana 2014
Please fill out this form to officially register for the April 19th Global Brigades Exchange at Indiana University.
We look forward to seeing you there!
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* Indicates required question
Name
*
Your answer
Email Address
*
To be used only to send you details for the event
Your answer
Phone Number
*
To be used only to contact you in case of a last minute change on the day of the event
Your answer
University
*
Your answer
Program
*
(Medical, Dental, Water...)
Your answer
Do you need a place to stay while attending the Exchange?
*
Usually this will be a local Brigader that can host you
Yes
No
Do you have any dietary restrictions?
Your answer
Is there any topic of discussion that most interests you for the Exchange?
Your answer
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