2017 Camino Peace Pilgrimage Application
20-28 May, 2017 | Program and Scholarship Application

All non-students are required to pay a $10 application fee which will be invoiced through PayPal once this form is complete.

If you haven't already, please have a mentor, teacher, or advisor send a letter of recommendation to Ben Lindwall (ben@heartbeatjourney.org). We must receive this no later than 1 March 2017.

Travel insurance must be purchased before trip and policy number provided.

If you have any questions, please contact Ben Lindwall, ben@heartbeatjourney.org

Last name
Your answer
First name
Your answer
Date of birth
MM
/
DD
/
YYYY
Street address
Your answer
City
Your answer
State/Province
Your answer
Country
Your answer
Zip/postal code
Your answer
E-mail address
Your answer
Can we add you to our Heartbeat email newsletter?
Phone number
Your answer
Gender
Age
Your answer
Nationality
Your answer
Religion/spiritual practice
Occupation/student/other
Your answer
Students, please list area of study
Your answer
Students, please list your current year at university
Your answer
Education, certificates, or special training
Your answer
Name EXACTLY as it appears on your passport
Your answer
Country issuing passport
Your answer
Passport number
Your answer
Passport expiration
MM
/
DD
/
YYYY
List food allergies and/or any hearing, vision, or mobility needs
Your answer
List any medical conditions
Your answer
Can you walk up to 18 miles/29km a day, multiple days in a row?
Access to vegetarian or gluten-free meals can be limited in northern Spain. Often there is mostly pork, chicken and pasta on the dinner menu and pastries or bread for breakfast. Those avoiding meat or gluten should plan to bring and purchase extra food during our time in the markets. Please select food preference below (select all that apply).
Required
Are you able to help translate Spanish for the group?
Please check one
If you are applying for a scholarship, please share about why you are seeking financial assistance
Your answer
Current source of income
How did you hear about this opportunity?
Emergency Contact information
Last name
Your answer
First name
Your answer
Relationship
Your answer
Phone number (include country code)
Your answer
Mobile phone number (include country code)
Your answer
Essay
Please limit responses to 150 words or less for each question below.
Please describe why you would like to attend
Your answer
Please describe your faith background and current approach to spirituality
Your answer
Please tell us how or what you might contribute as a member of the group
Your answer
Please sign by entering your name below
Your answer
Today's date
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms