72nd Martyr's Day Trip Registration Form

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If you are driving from San Diego to Sacramento to attend the Martyr's Day ceremony on Friday 8/12, Karen Organization of San Diego (KOSD) may be able to cover your gasoline costs (actual costs up to $250 per vehicle). Due to limited funding, priority will be given to the following individuals:
- refugees from Burma who currently live in San Diego
- those who have been regularly involved with KOSD's programs

*Please note that participating in this event is voluntary and KOSD will not take any responsibility for injury, loss, or damage sustained during travels or at the event itself.

To be considered for the financial support to cover gasoline costs:
1) Submit this registration form by 8/10/2022.
2) Check-in at the event with KOSD's Community Organizer, Prosperity Land (619-320-8775, prosperity@karensandiego.org).
3) Submit copies of your gasoline receipts to Prosperity Land by 8/31/20222

Driver's Full Legal Name *

Date of Birth *

YYYY

Primary Phone Number *

Email *

Home Address *

Please select all that apply to you. Due to limited funding, priority will be given to these individuals.

I am a refugee from Burma and currently live in San Diego.

I have been regularly involved with KOSD's Programs.

Number of people you will be driving to the event *

Please list the names of everyone you will be driving to the event *

Emergency Contact 1 (Please enter their name and phone number) *

Emergency Contact 2 (Please enter their name and phone number) *

Any comments or questions?

Submit

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