Building Project Registration Form

Name As It Appears on Your Passport *
Name As It Appears on Your Passport
Passport Expiration Date
Passport Expiration Date
Date of Birth
Date of Birth
Address
Address
Phone 1
Phone 1
Cell Phone
Cell Phone
Emergency Contact Phone
Emergency Contact Phone

I agree to pay $2,100 by Sunday, May 3, 2020. This payment includes round trip airfare from JFK to Guayaquil, Ecuador, and all other project expenses excluding 1 evening meal offsite, expenses incurred at the beach, any daily purchases such as water, ice cream, etc. and lunch and supper during the travel weekend.  

I understand that as each payment is made, it will be non-refundable.   I also understand that AUF now requires that each participant purchase trip cancellation insurance by the registration due date above.   Also, Ecuador requires proof of traveler’s accident and medical insurance.

 Signature: _________________________    Date: __________

 Printed Name: _______________________________________

 Checks payable to: ADOPTA UNA FAMILIA Inc.
Mail to: Linda Smith at 136 Whiting Lane – W. Hartford, CT 06119

For online payments, which include a service charge of approximately 3%
pay here

 Trip Insurance companies include but are not limited to the following:   
AAA, AIG Travel Guard, Allianz, Insuremytrip.com, Roamright.com, and Travelinsurance.com 

To download a copy of this form, please click here

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