Application for the 2011 Guatemala Quaker Tour

Complete this application and send it by email to:
progresa3@gmail.com or mardugan@earthlink.net

We need your application and deposit by December 31 2010

Name(s)

Address

Home phone

Work phone

FAX

e-mail

Preferred roommate

Emergency contact

Relationship to you

Your age

Any health problems?

Special dietary needs

Other needs

Do you have any questions? Please contact us.
Loren Lacelle at progresa3@gmail.com  Phone/Fax: 011-502-7849-5970 in Guatemala
Martha Dugan at mardugan@earthlink.net Phone: 011-502-7832-5653 in Guatemala
Mary Thompson at marydee2@cox.net Phone/fax: 805-965-9995 in CA