Veterans For Peace Application for Nicaragua Delegation
Thank you for your interest in joining the Veterans For Peace delegation to Nicaragua on July 12-21, 2019. Please provide us with the following information. We will do our best to get back to you soon so that you can begin making your travel plans.

If you want to mail in a copy, print out this application and mail it to our National Office: https://www.veteransforpeace.org/files/2815/6045/9480/APPLICATION_for_Nica_Delegation.pdf

Email address *
Name *
Your answer
Address (Street, City, State and Zip Code) *
Your answer
Phone *
Your answer
Are you a veteran? *
Are you a member of Veterans For Peace *
Please list any veterans peace groups you are affiliated with: *
Your answer
Please list any other peace, solidarity or social justice groups you have worked with: *
Your answer
Have you visited Nicaragua or Latin America before? If so, in what capacity? *
Your answer
Do you speak Spanish? *
Please list two references with contact information. *
Your answer
Do you have any medical conditions that we should know about in case of emergency, or medications you must have? If so, please list/explain: *
Your answer
Please give at least one person (next of kin) we can contact if you become ill in Nicaragua *
Your answer
Please explain briefly (three or four sentences) why you want to be part of this delegation. *
Your answer
Will you or your group be able to organize report-back presentations upon your return? *
Your answer
Will you be able to raise $1,200 to cover the costs of this trip? (We strongly encourage you and your friends to do so. Limited travel assistance funds may be available to those who absolutely need further help.) *
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Veterans For Peace, Inc.. Report Abuse - Terms of Service