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Schools for Chiapas Travel Application
Welcome to the Schools for Chiapas travel application. We have recently streamlined and simplified our application. Please email us at
info@schoolsforchiapas.org
if you have questions or need assistance.
If you are ready to reserve your spot on one of our upcoming delegations, please click on the following link
http://www.schoolsforchiapas.org/english/store/catalog.html?producttype=Trips%2Bto%2BChiapas
to pay your delegation fee.
Reserve your spot today! We hope to see you soon in Chiapas!
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* Indicates required question
First Name
*
Your answer
Middle Name
Your answer
Last Name
*
Your answer
Which trip are you interested in?
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Trip #999 For a better world ~ Special focus Chiapas travel
Trip #119: Mural Painting at Galeano’s school in La Realidad #1 – March 29 to April 4, 2015
Trip#120: Mural Painting at Galeano’s school in La Realidad #2 – April 5, to April 11, 2015
Don't know for sure which trip I want to take.
Required
E-mail Address
*
Your answer
Street Address
*
Your answer
Second Street Address (if necessary)
Your answer
City
*
Your answer
State
*
Your answer
Postal Code
*
Your answer
Country
*
Your answer
Home Phone Number
*
Your answer
Cell Phone Number
Your answer
Age
*
Your answer
Gender
*
Female
Male
Required
Passport Number
Your answer
Your language skills: English
*
Choose
None
Basic
Intermediate
Advanced
Fluent
Your language skills: Spanish
*
Choose
None
Basic
Intermediate
Advanced
Fluent
Other Languages?
Your answer
Medical Info:
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Health Insurance
yes
no
Required
Allergies
*
Your answer
Drugs or medications?
*
Choose
yes
no
If yes, describe.
Your answer
Dietary Practices
*
Eat everything
No meat
No dairy
No eggs
Raw only
Other:
Required
Emergency Contact
*
Emergency Contact #1 (name address, phone and email)
Your answer
Emergency Contact
*
Emergency Contact #2 (name address, phone and email)
Your answer
How did you hear about the work of Schools for Chiapas and why do you want to help out?
*
Your answer
What are your primary goals of participating in this program? How do you support causes in your own country?
*
Your answer
What are your travel plans?
*
Do you know the dates and/or method of travel?
Your answer
Any other comments or questions?
If you need an immediate response, please email us at
info@schoolsforchiapas.org
.
Your answer
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