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Group, if any, with whom you are traveling (school, parish, or organizer name)
Date of FIAT TRIPS 2020
*
January 4 - January 11
January 18 - January 25 (FILLED)
January 25 - February 1
March 7 - March 14
March 14 - March 21
May 11 - May 21
May 30 - June 8
June 9 - June 17
June 24 - July 2
July 6 - July 13 (FILLED)
July 13 - July 21 (FILLED)
July 22 - July 30
* Groups of 10 or more may apply for dates not listed by contacting Lynette Kyle at
info@projectfiat.org
T-Shirt size
S
M
L
XL
2X
Your Name
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
United States
Canada
Country
(Other countries please apply using our
printable form
.)
Daytime Telephone
*
Evening Telephone
Email Address
*
Date of Birth
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Gender
Male
Female
Passport
Passport Status
*
I already have my passport.
I have applied for my passport.
Your name how it will appear on your Passport
*
NAME MUST MATCH PASSPORT OR THERE WILL BE A CHANGE FEE FOR AIRLINE TICKET
Country of passport
*
United States
Canada
Country
Passport Date of Issue
*
Date Format: MM slash DD slash YYYY
Passport Date of Expiration
*
Date Format: MM slash DD slash YYYY
Nationality (according to passport)
*
Expected Date of Receipt of Passport
*
Date Format: MM slash DD slash YYYY
Health Insurance
Health Insurance Confirmation
*
I have health insurance that will cover me abroad.
I do not have health insurance that will cover me abroad, and will be responsible for any health related expenses that occur.
Health Insurance Carrier
Policy Number
Group Number, if applicable
Name of Insured
Relationship of Insured to Applicant
Insurance Company Telephone
Please list any allergies
*
e.g. Food, Latex, Medicine, Environmental
Emergency Contact Information
Emergency Contact Name
Relationship to Applicant
Daytime Telephone
Evening Telephone
Contact Information for Parents
Contact information for parent(s) is required for students. This information is optional for others.
Father's Name
Father's Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
United States
Canada
Country
Father's Daytime Telephone
Father's Evening Telephone
Mother's Name
Mother's Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
United States
Canada
Country
Mother's Daytime Telephone
Mother's Evening Telephone
Did we forget anything? If there's more you would like to tell us about yourself, include it here
Agree to Policies
*
I have read and agree to the policies of Project FIAT International as detailed in the
Project FIAT Manual.
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