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Haiti Earthship Registration Form
Thank you for joining the Earthship Haiti adventure in January 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 January 04 at 9AM and we will be done January 29 at 5PM. Please plan to arrive and depart accordingly.
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?
1 Online Earthship Academy + Four week Field Study (January 4-29): USD $2,500. Includes full access to the Earthship Online Academy, a four week field study in Haiti and lectures in Haiti with Phil Basehart and team.
2 Online Earthship Academy + Two week Field Study (January 4-17): USD $1,500. Includes full access to the Earthship Online Academy, a two week field study in Haiti and lectures in Haiti with Phil Basehart and team.
3 Field study - four weeks: USD $1,500. A field study is the Earthship internship, which allows you to work on site along the specialized Earthship crew but does not include access to the Earthship Online Academy.
4 Field study - two weeks: USD $750. Come and join us for the first two weeks of the project only (January 4-17, 2021)
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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
Occupation or special skills
We like to encourage knowledge transfer among volunteers as well as the local community. If you have any special knowledge or skills (first aid certification etc) that you think would be of help please let us know. Thanks! :)
Your answer
What languages do you speak?
Your answer
What does cultural awareness mean to you?
Your answer
Describe what “sustainability” means to you.
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
Are you prepared to be self reliant for one month (including providing for your own dietary needs for one month)?
Your answer
Describe why you are interested in Earthships and what inspired you to apply for the International Earthship Academy?
Your answer
What existing skills or interests do you possess that you hope to apply to your Academy experience?
Your answer
Is there any other information that we should be aware of?
Your answer
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