Expanding OpportunitiesService Journey to Kenya 2007
Application Form
Date:________________
| ________________________________________ Name |
________________________ Phone |
| ________________________________________ Address |
________________________ Fax |
| _____________________________________ Address 2 |
________________________ |
| _____________________________________ City ------------------State---------- Zip |
________________________ Date of Birth |
| _______________________________________________ Signature |
_________________ Date |
| Journey Dates: _________________ | Concentration Area __________________ |
| Total Due: ___________________________ | Please Book my flight __________ |
| Amount of Deposit_____________________ |
Please print and mail to:
Expanding Opportunities
84 Payson Road
Brooks, Me
04921
You may pay the fee with Cash, Check, Visa, MasterCard, or
PayPal
Paying by Credit Card.
| _________________________ Credit Card Number |
______________ Expiration Date |
___________________ Type of Card |
Paying by PayPal - Use PayPal ID info@expandingopportunities.org
| Service Journey Home | Service Opportunities | Schedule |
| Printable Application form | Liability Waiver | Permission for Minor |
| For General Information |
For more Information:
Call
1-888-760-7943; 1-207-722-3708
Email: info@expandingopportunities.org
Visit:
www.exop.org