Online Application

Project FIAT El Salvador Application

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:
	March 1-8 March 8-15 March 15-22 March 25-April 1	May 27-June 4 June 5-13 (filled) June 14-22 (filled) June 24-July 2	July 5-13 July 15-23 August 4-12 August 14-22
	T-Shirt size:

	Name as it appears on Passport:

	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:
	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.