Project FIAT

If you would rather print an application out and mail it, click for our Application in PDF format

Group, if any, with whom you are traveling (school, parish, or organizer name):

Date of FIAT trip:

	T-Shirt size:

	Name as it appears on Passport:
	NAME MUST MATCH PASSPORT OR THERE WILL BE A CHANGE FEE FOR AIRLINE TICKET

	Address Line 1:
	Address Line 2:
	City:
	American State / Canadian Province:
	Zip Code / Postal Code:
Country: United States Canada (Other countries please apply using our printable form.)

	Telephone:	Day : Evening:
	Email address:

	Date of Birth:	Month: Day: Year:
	Gender	Male Female
	Country of passport
	Passport Date of Issue
	Passport Date of Expiration
	Nationality (according to passport)

	Health Insurance Carrier:
	Policy Number:
	Group Number, if applicable:
	Name of Insured:
	Relationship of Insured to Applicant:
	Insurance Company Telephone:

	Please list any allergies:
	Emergency Contact Name:
	Relationship to Applicant:
	Daytime Telephone Number:
	Evening Telephone Number:

Contact information for parent(s) is required for students. This information is optional for others.
	Father's Name:
	Father's Address:
	Father's Telephone	Day : Evening:

	Mother's Name:
	Mother's Address:
	Mother's Telephone	Day : Evening:

	Did we forget anything? If there's more you would like to tell us about yourself, include it here:
	I have read and agree to the policies of Project FIAT International as detailed in the Project FIAT Manual.