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CISPES 2017 May Day Delegation Application
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* Indicates required question
Full name
*
as it appears on your passport
Your answer
Name you prefer to go by
Your answer
Date of Birth
*
You must be 18 years or older to participate
MM
/
DD
/
YYYY
Gender
Your answer
Passport Expiration Date
*
If your passport expires within 6 months of the date of your travel date to El Salvador, you may not be allowed into the country. If your passport expires soon, we strongly recommend that you renew it.
MM
/
DD
/
YYYY
Email address
*
Your answer
Phone number
*
This should be the best phone number to contact you at
Your answer
Alternate phone number
Your answer
Street address
*
Your answer
City, State
*
Your answer
Zip Code
*
Your answer
Please list two references, preferably someone involved in solidarity work, a social justice organization, a teacher or mentor.
*
List your references' name, title, organization or institution, phone number and email address
Your answer
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