St George & St Joseph's Church Youth Group

Sign-up Form for Kenya Mission Trip
All information about the trip can be found at www.stgjyouth.ca/kenya2013
Cost is $1700 (including KLM airfare, lodging and food)
1) Sign-up here and pay $150 non-refundable deposit by March 18th
2) Pay the balance by April 22nd

* indicates required

First Name (as written in the passport) *

Middle Name(s) (as written in the passport)

Last Name (as written in the passport) *

Email Address *

Phone Number *

( ) -

Passport Number *

Passport Expiry Date *

DD/MM/YYYY

Date of Birth *

DD/MM/YYYY

Any Comments?