Haiti TU Honors 2018 Pre-Passport 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 should only be filled out by those who have not yet received their passport. Once you receive your passport, you must fill out the standard registration form (GITUHTREG) 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
*
*
Date *
Date
Form# GITUHTPPREG Electronic