Peru - 2020
Fill out the following registration/bio sheet and return with $1000 on/before March 1st.
Information will be kept confidential and is for use by Footbridge, Inc. to secure airline tickets, travel insurance, etc.
Full Name (As Appears on Passport) *
Your answer
Name you "go by" *
Your answer
Passport # *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Email Address *
Your answer
D.O.B. (For Travel Insurance) *
MM
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DD
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YYYY
Home Phone *
Your answer
Work Phone *
Your answer
Cell Phone *
Your answer
Best way for you to receive trip information/updates? *
Occupation *
Your answer
Employer *
Your answer
Member/Attending which Church? *
Your answer
First mission trip over seas? *
T-Shirt Size? *
Scrub top size? *
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Please list your interest / ability that would help our clinics in Peru. *
¿Habla español? *
¿Puede usted traducir? *
*Health Concern:
***One Health Concern that we haven’t had to mention on too many of our Short Term Trips is ALTTITUDE SICKNESS. The altitude in Curahuasi is 9,100 feet above sea level. Part of the problem is not just the num- ber of feet, but that you will be flying from Lima, which is at sea level, to 9,100 ft. in an hour, without time to acclimate. We will discuss, before we travel, taking Diamox (diuretic) or precautions for altitude sickness.
IF YOU HAVE HEART PROBLEMS, CONSULT YOUR DOCTOR BEFORE GOING ON THIS TRIP!
Comments/Requests pertaining to health concerns
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