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Haiti Earthship Registration Form
Thank you for joining the Earthship Haiti adventure in October 2021. Please complete the below information as accurately as possible. By completing and submitting this form, you are officially reserving a spot to participate in this project. Your participation will become official once we receive payment from you and we will issue you with a receipt. Thank you!
We will be assisting you as best as we can but please remember this is an adventure, expect the unexpected and come prepared. Thank you!
The project will start on October 18 at 9AM and the last day will be November 12. Please plan to arrive on October 17 before 12PM (noon) in PortAuPrince and depart on November after 12PM (noon) from PortAuPrince so that we can travel as a group to and from La Gonave and save on cost. We will help arrange this transfer and keep the cost down as much as possible.
The project is located in La Gonave, Haiti.
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Email
*
Your email
Full name
*
As shown in passport (include middle name).
Your answer
Other name
What do you like to be called if different from your passport name.
Your answer
Gender
*
Male
Female
Other:
What option of the below would you like to sign up for?
FOUR WEEKS: $1200
TWO WEEKS: $750
1 WEEK: $400
RETURNING VOLUNTEER 4 WEEKS: $800
RETURNING VOLUNTEER 2 WEEKS: $500
RETURNING VOLUNTEER 1 WEEK: $300
ACADEMY STUDENT/BPE VOLUNTEER 4 WEEKS: $1,000
ACADEMY STUDENT/BPE VOLUNTEER 2 WEEKS: $750
ACADEMY STUDENT/BPE VOLUNTEER 1 WEEK: $400
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Date of Birth
*
MM
/
DD
/
YYYY
Phone number
Your answer
Current full address (include city, state and country)
Place of current residency - please include Street name, number, city, state and country
Your answer
Emergency contact 1
*
Name and contact details (phone number).
Your answer
Emergency contact 2
*
Name and contact details (phone number).
Your answer
Travel insurance details (Provider, policy number, etc)
Full repatriation cover mandatory
Your answer
Flight numbers, dates and times of arrival and departure in and from Port Au Prince (if already available).
Please plan to arrive on October 17 before 12PM (noon) in PortAuPrince and depart on November after 12PM (noon) from PortAuPrince so that we can travel as a group to and from La Gonave and save on cost. We will help arrange this transfer and keep the cost down as much as possible (between $100-$150 round trip per person).
Your answer
Please write a short description of yourself and any skills or hobbies that may apply to the project (occupation, first aid kit certification, languages, interests...)
Your answer
Are you able to step out your typical comfort zone and handle extreme situation? Have you ever camped and lived with a large group?
Your answer
Is there any other information that we should be aware of?
Your answer
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