Haiti Project.org

Mission Trip Form

Name:
Address:
Day Phone:
Evening Phone:
Email:
Occupation:
Parish (if applicable)
   
Trip Date Desired:
  While in Haiti, I would be interested in contributing in these areas:
 
sewing and/or crafts agricultural farming/husbandry
carpentry (e.g. building furniture) religion
building construction photography
painting music, art, drama
medical or dental education (e.g. english instruction)
   
Other - Specify area of expertise:  
Please specify:

   
  Briefly explain your interest in going to Haiti:
 
 

Type of Credit Card:

  VISA  MASTERCARD  DISCOVER

Name on Credit Card
Credit Card Number: - - -
3 DIGIT Security Code:
Expiration Date: / 20
Trip Deposit: $500 will be charged to your credit card as a deposit to reserve your place on the trip requested. The $500 deposit is nonrefundable after a nonrefundable/nontransferable airline ticket has been purchased. Haitian politics should not effect our trip schedule. However, everyone's safety is our first concern and trips may be canceled or postponed if we are so advised. In the event of a trip cancellation by the Haiti Project, every effort will be made to reimburse funds to the participants.
    

Questions? Contact our Coordinator:

Hannah Brown Haiti Project Coordinator
414-702-8126 5934 Town Hall Drive
hannah@haitiproject.org Sun Prairie, WI 53590

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