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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