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Get on the boat!

Every person applying to go with this group to Gaza must have an up-to-date file, which will be kept and maintained by a trusted member of our planning committee. Because of the large number of persons that could potentially travel in the coming months, and because of the current political and military situation in the Occupied Territories, these files must be complete so that we are ready in the office to deal with every situation. For this reason, we ask for all of the information we might need for consideration of your eligibility. Once you have submitted a complete application, a phone interview will be scheduled to discuss it.

Please note that this is not a secure form. If you are uncomfortable sending this information over the Internet, please fill out the form, print it, and fax it to us at (xxx) xxx-xxxx. Your application will NOT be processed until we have all of the information requested.
JOIN US! Photo © Sam Tsohonis
PERSONAL INFORMATION
NAME

BIO
(foreign travel, peace work, other exp.)
SECONDARY PHONE
OTHER PHONE
EMAIL ADDRESS
OCCUPATION
FLUENT LANGUAGES
PASSPORT INFORMATION
PASSPORT # DATES OF TRAVEL
EXPIRATION DATE
PLACE OF ISSUE
DATE OF ISSUE LAST VISIT TO PALESTINE
NATIONALITY
DATE OF BIRTH
PLACE OF BIRTH
HEALTH INFORMATION
List of current and previous health conditions. In completing this, please note any conditions that may in any way relate to the rigor of traveling on the Sea or in the Occupied Territories– e.g., long drives without modern restroom facilities and sometimes without food stops. It is necessary to indicate ANY medical concerns; if you have ever suffered from heart disease, respiratory conditions (including asthma), diabetes or other dietary conditions (e.g., hypoglycemia). Add other documents or pages of explanation as necessary:
NOTABLE HEALTH CONDITIONS
MEDICATIONS TAKEN
ALLERGIES
PERSONAL REFERENCES

List at least two persons with whom you have worked closely in recent years.
Reference 1   Reference 2
NAME   NAME
PHONE # PHONE #
EMAIL
EMERGENCY CONTACTS

List at least two persons who can be reached in case of a medical emergency.
Contact 1   Contact 2
NAME   NAME
PHONE # PHONE #
EMAIL

 
this is not a secure form. If you are uncomfortable sending this information over the Internet, please fill out the form, print it, and fax it to us at (xxx) xxx-xxxx. Your application will NOT be processed until we have all of the information requested.
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