Work Week Registration

Come to Colima to work, but also to meet the children, visit with Mexican Rotarians, and learn more about the people and culture of western Mexico! See options below for faxing or mailing your information.If you need more info, please also see:
or e-mail us at info@projectamigo.org with any questions. To fill out by hand, please print and send or fax.

First name
Last name
Preferred Name
Street address
City
State or province
Zip or postal code
Country

Mobile # you may be bringing with you
- Area Code Phone Number
Alternate phone # to reach you prior
- Area Code Phone Number
E-mail
Alternate e-mail
Rotary club
Rotary district
T-Shirt-Size

S M L XL XXL

Work week dates

November 5-13, 2011 December 10-18, 2011 January 7-15, 2011 February 18-26, 2011 March 3-11, 2011 Other
Please list with whom you are traveling and their relationship to you
My party would prefer (number of rooms and beds
We arrive in

Guadalajara Manzanillo Colima
Arrival date and time
- Month - Day at Year / Hour Minutes
Airline and Flt#
Departure date and time
- Month - Day at Year / Hour Minutes
Airline and Flt#
My/our dietery preferences are

No meat No dairy No sugar Other
I/we have these special needs

Smoke Have asthma Have diabets Other

Please rate your level of speaking Spanish

	1	2	3	4	5	6	7	8	9	10
Not at all											Fluently

I/we have the following skills

Electrical Plumbing Computers Other
In Case of emergency, contact
Name and Phone
A deposit of one-half of the requested donation of $600 USD per person is required to hold your place.
Click to edit

I have used my credit card for an online donation of: I am mailing my check to the Novato address my donation of:
$ (dollar amount)
# (number of places)
Comments on anything you'd like us to know!
You're ready to register! All information you provide is strictly confidential. Please see our privacy policy.

Click "Submit"
- to complete the registration online
Click "Print Form"
- to fax to (775) 259-2773
- or to mail to: Project Amigo, 14 Commercial Blvd # 119, Novato, CA 94949
We look forward to working with you!
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