Name *

First Name

Last Name

Phone *

(###)

###

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Impact Trips *

Select the Impact trip and commitment you are agreeing to below.

Portland, OR: I am making a financial commitment to the Portland, OR trip in May 2023. I will pay my initial deposit of $50 by March 20, and will then be responsible for raising the remaining funds, totaling $650. If I back out for any reason I will be responsible for paying the remaining balance of my airline ticket.

South Asia: I am making a financial commitment to the South Asia trip in May 2023. I will pay my initial deposit of $50 by March 20, and will then be responsible for raising the remaining funds, totaling $2,000. If I back out for any reason I will be responsible for paying the remaining balance of my airline ticket.

Signature *

First Name

Last Name

Authorization *

I agree that the signature will be the electronic representation of my signature for all purposes pertaining to this document.