Haiti TU Honors 2018 Registration Form

I understand that all participants must also sign and email (info@globalincite.com) the Global Incite Agreement and Terms (HA0518) document.

This registration form is for those who currently have a passport. If you have not received your passport, please fill out the pre-passport registration form located here

Travel Dates: May 16-22, 2018 Trip Cost: $1892 Includes: RT flight from ATL to PAP; transportation within Haiti, travel emergency medical insurance, Global Incite coordinator and guided services as listed; shared accommodations; two meals per day as listed within the itinerary (airport meals not included); visits and excursions as listed, coordination fees, country entrance and departure fees, service learning experience, pre-departure support, orientation, private online group support. Single Supplement: $485 Pay Online: www.globalincite.com/pay $400 (deposit) - Due Tuesday, October 20, 2017 - Code 1020; $500 - Due December 10, 2017 - Code - 1210; $500 - Due January 30, 2018 - Code - 1300; $492 - Due February 20, 2018 - Code - 2200; Late fee: $75 - Code - 0750
Contact Information: Global Incite PO Box 27089, Washington, DC 20038-7089 Email: info@globalincite.com Ph: +1.202.494.4497
First Name (Given Name):
Middle Name
Last Name (Surname)
Date of Birth *
Date of Birth
Passport Date of Expiration *
Passport Date of Expiration
*
*
Date *
Date
Form# GITUHTREG Electronic