home page
 
 
 
             
 
 
 
 
 
 
 
(Please fill in the text boxes below and click the SUBMIT button)
 
Background Information
 
 Today's Date
 Trip Dates
 
 Your Email Address
Please enter information below as it appears
exactly on your passport:
 
 Name
 Phone
 Address
 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
 
 Address    City/State/Zip
 
 Phone    Email
 
Additional Questions
 How many times have you traveled from the US to Cuba?
 When was the last time you went to Cuba?
 Under what license?
 What is your reason for traveling to Cuba?
Release of Liability and Approval of Ministry
If I am accepted, I will:
  • Adhere to all of the instructions and guidelines provided by AmericasRelief Team regarding my trip, including the delivery of humanitarian aid to specified locations;
  • Keep a copy of my travel documents (i.e., flight ticket, authorization letter, etc.) for 5 years, should the authorities make an investigation;
  • Be responsible and prompt with all stated financial aspects related to my trip;
  • Participate in filling out a post trip report for AmericasRelief Team;
  • Wholeheartedly cooperate with AmericasRelief Team staff, personnel and representatives in the U.S. as well as Cuba.
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 AmericasRelief Team 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 AmericasRelief Team 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.
Typing your full name in this box
constitutes your electronic signature:
 Signed
 Date
 
 
 
 
 
Thank you!