Please submit all required information, incomplete applications will not be accepted. Note: $200 deposit is required at the time of submitting this application to hold your place, or no later than 2 months prior to tour start date. Final payment due 45 days prior to tour start date.         Trip you are applying for Departure Date          Name Name (as it appears on your passport) (as you prefer to be called)         Father’s Name (for Iran travelers only) Address City State Zip Home Phone Work Phone Fax *E-Mail Date of Birth Age Birthplace Occupation Employer (if retired, please state from what field) Ethnic Background (optional) Gender     Passport Information: I am a citizen of   Passport Number State Where Issued Date of Issue Date of Expiration     Person to contact in case of emergency: Relation   Email City State Day Phone Evening Phone     Language abilities other than English: (Please indicate whether basic, intermediate, conversational or fluent)   Spanish Portuguese French Hebrew Arabic Other     Accommodations: Tour price is for double occupancy (which is not always guaranteed). Single room accommodations require an additional fee. Please mark your preferences:   Non-Smoking Smoking Do you want a single room? Yes No If No: Do you have a roommate? Yes No If Yes: Name We will assign a roommate, if available. Gender preference:     What are the themes/topics that interest you? (Please check all that apply):   Labor rights/ Sweatshops Corporate Accountability Trade & Investment Fair Trade & Econ Alternatives Militarization Intl Democracy & Elections Peace & Conflict Prisons and Police Brutality Drug War Poverty & Homelessness Sanctions & Embargoes Migration & Immigration Environment & Sustainable Development Environmental Racism Land & Agriculture Food & Hunger Women Children Gay/Lesbian/Bisexual/Transgender Indigenous People Art & Culture Religion & Spirituality Health & Healing Energy Education (Please answer all questions.) Why do you want to go to this destination? What do you expect to gain from participating? Please state the ways in which your work or studies relate to the issues or themes pertaining to this Reality Tour: How will you share your learning experience when you return home? In what ways can you contribute to the worldwide movement for economic, environmental, social and human rights upon your return? Do you have any special dietary or medical needs? At times we are able to arrange private meetings for travelers, in addition to the general itinerary of the group. Is there a particular person or organization you would like to meet? Have you ever traveled outside the US? If so, where?     How did you hear about this trip?   The Internet/website (please specify Global Exchange website or other) Global Exchange store Publication (indicate which one) Event (indicate which one) From a friend (name) Radio show (please specify) Global Exchange mailing Other (please specify) We are in regular contact with journalists who want to write stories about our trips, or events happening during our scheduled delegations. Would you be interested in being called for an interview? Yes No In order to facilitate post-tour communication, we send each member of the group a list of fellow participants’ contact information. If you do not want to be on this list, please check here FOR CUBA AND AFGHANISTAN TRAVELERS ONLY: After traveling to these destinations, we find that many participants make new friends they want to keep in touch with; however, the postal systems between the US and Cuba/Afghanistan are unreliable. In the past, we have connected former participants with new ones in order to share their experiences, make new friends and deliver or mail a letter in Havana/Kabul. Are you willing to have your phone number given to a past participant so they can contact you regarding a friendly delivery? Yes No