KATRINA RELIEF TRIP REGISTRATION FORM

If you feel moved to join a Katrina Relief trip, tell us about yourself:

First Name

Last Name

Mail Address

Work Phone

Home Phone

Cell Phone

E-mail

Organization or Church

Please tell us about your plans for participating, even if they're just tentative right now and all you want is to be kept informed as trips are established.  When would you like to go?

Specific trip (see Trip Schedule page for specific dates and fill in the blank)

I'm not sure yet; perhaps in (fill in)

Specific date(s) not yet on Trip Schedule (fill in)

Who else do you know who might also want to go (so we may get in touch with them)?

(fill in)