You may complete the Trip Application Form in two ways:
1. Fill in the text boxes (below) and click the SUBMIT button.
2. Download a printable version in PDF form by
clicking here
.
Background Information
Today's Date
Region Visiting
Tentative Trip Dates
Phone
Email
Were you referred by anyone? (a recruiter or other agency)
Yes
No
If yes, who/what agency?
The Following Information
Should Be Listed
EXACTLY
As It Appears On Your Passport
Full Name
Home Address
Apartment
Country
City
State
Zip
Sex
Date of Birth
Marital Status
Occupation
Mother's Maiden Name
Passport Number
Passport Expiration Date
Contact In Case Of Emergency
Name
Relationship
Phone
Email
Home Address
Apartment
Country
City
State
Zip
Additional Questions
How many times have you traveled from the US to Cuba?
If born in Cuba, when did you leave?
Is your Cuban passport up to date? Provide expiration date:
When was the last time you went to Cuba for missionary purposes?
Which license did you use?
Check Those You Need Assistance With
Itinerary
Transportation
Guide
Translator
Lodging
Flight Arrangements
Travel Agreements, Release of Liability, Approval of Ministry
Traveler’s Agreement
The main purpose of my travel to Cuba will be to engage in certain travel-related and additional transactions that are directly incident to activities noted on General License No. GNR3CFR as defined by OFAC and permitted by Cuba with a tourist visa under the auspices of this organization.
If I am accepted, I agree to become a member of the organization’s Support Council, and adhere to all of the instructions and guidelines given by the trip facilitator regarding my trip, including the attendance of a worship service of my choice while in Cuba, with proof of attendance. Keep a copy of my travel documents (i.e. Flight ticket, authorization letter, etc.), which I understand it is mandated that I keep my travel records for 5 years, and cooperate with staff, personnel and representatives in the U.S. as well as Cuba.
Release Of Liability
In consideration for being accepted and allowed to participate in this project and activities associated with its programs and locations, I personally assume responsibility for my actions, and release the trip facilitator and any associated groups or ministries, their board members, employees and missionaries from loss, injury or damage to myself or my property; provided that nothing contained herein shall excuse the license provider and any associated groups or ministries, their board members, employees and missionaries from the responsibility to act with reasonable care for the safety of myself or my property.
Disclaimer & Affidavit
I
, have read and acknowledge the above Release of Liability, Disclaimer and Agreement, and fully understand the risks involved with international travel including Cuba, and further understand that the organization cannot anticipate or control actions of any government. Therefore I do not hold this organization or any of its affiliates responsible for any cost incurred as a result for those reasons.
(Typing your full name in the box below constitutes your electronic signature)
Participant Signature
Date
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