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Haiti Trip Application
Trip Dates: January 8-17, 2019
*
Indicates required field
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Email
*
Passport information
Do you have a valid passport?
*
Choose one
Yes
No
If choosing no, you will need to apply for one. You should do this as soon as possible.
Name as it EXACTLY appears on Passport
*
Passport Number
*
Passport Issue Date
*
Passport Expiration Date
*
Will this be your first trip with Lavi Project?
*
Yes, this will be my first
No, I have traveled with Lavi Project before
Any Additional Comments
*
Submit
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