ACTION-REFLECTION TRIP TO PERU
INFORMATION AND APPLICATION
Presbyterian Hunger Program (Joining Hands and Environmental Ministries)
In collaboration with Mission Co-Workers
December 5-12, 2014Lima, Peru
Focus: to exploretheUnited Nations Framework Convention on Climate Change Conference on the Parties (COP) 20, to visitsites of social-environmental concern, and to observe and/or participate in the Bolivia-Peru environmental youth congress organized by Joining Hands networks in those countries.
In-country costs are expected to be around $800/person. You are responsible for booking your own flight, in consultation with our country hosts (most likely red-eye flights the nights of Dec 4 and 12).The deadline for application is August 15, 2014. Please email the completed application to . Selected participants will be notified Aug 31, at which point a deposit of $400 confirms your participation.
NAME:______
Dr. Rev. Mrs. Ms. Miss Title First Name Middle Initial Last Name
PHONE: (H)______(W)______(C)______
MAILING ADDRESS:______
______
EMAIL ADDRESS: ______
Most rooms will be double. In case you have to share, name of roommate request: ______
CONGREGATION/PRESBYTERY/COLLEGE/COMMUNITY REPRESENTING: ______
______
Do you have previous travel experience outside the USA? ______
Do you speak Spanish? _____
Your present state of health is: EXCELLENT____GOOD____FAIR____
Do you have any: LIMITS ON EXERCISE______SPECIAL DIET______OTHER______
*This trip is rigorous, including reaching heights of 16,000 feet above sea level. Please consult your doctor if you’d like to consider prescription medication for altitude sickness before the trip. Special diets may be a challenge to accommodate; we will contact you if this seems to be the case.*
CANCELLATION POLICY
The cost of this visit has been computed based on group rates for ground transportation and accommodations. Therefore, any changes in the numbers of participants create changes in the fees required for the rest of the group and some cancellation penalties are incurred. In the event that a participant must cancel, for whatever reason,$100of your deposit may not be refundable, dependent on transportation, hotel, or other trip partner policies.
What interests you about traveling to Peru to explore the themes of climate change and social-environmental concerns?(100 words sufficient)
This trip is for both personal and theological reflection and for action related to issues explored. How do you plan to use and interpret your experience when you return? (100 words sufficient)
******************************************************************************************
If you have specific questions about the trip you may contact Rebecca Barnes at 888-728-7228 ext. 5426 or . Please return this form by Aug 15 email to .
Please Read and Sign this Agreement:
I agree to all the conditions relevant to the 2014 PHP Action-Reflection Trip to Peru for which I am applying. I will take part fully in all aspects of the trip including preliminary study as well as sharing information and taking action related to the themes of the trip once back home.
WAIVER OF CLAIM
I wish to participate in the 2014 PHP Action-Reflection Trip to Peru, sponsored by the Presbyterian Hunger Program,December 5-12, 2014. I understand that I am financially responsible for the $800 trip costs as well as my international flight between the United States and Peru.
I hereby acknowledge that the Presbyterian Hunger Program does not assume any liability for loss or damage to my personal property, or for injury, sickness or death arising out of participation in the tour. I, my successors and assigns, hereby waive any claims, demands or causes of action against the Presbyterian Hunger Program,Presbyterian Church (U.S.A.), its employees or agents for any loss or damage to my personal property or any injury, sickness or death, which may arise out of participation in the seminar, plus travel time.
Also, I have read and understand the above cancellation policy. I understand that, if I cancel from participation, up to a $100portion of my deposit may not be refundable.
______
Applicant’s signature Date
Please return this form by Aug 15 by email to .
Page 1 of 2