Haiti Initial Planning Haiti Team Leader Initial Planning Form Trip InformationTrip Date Requested* MM slash DD slash YYYY Location Requested* Galette Chambon Thoman Estimate the number of team membersMale* Female* Galette Chambon Hope Center has beds for 24 participants. Thoman Hope Center has beds for 28 participants. If extra accommodations are needed, please contact BGM to see IF extra space can be arranged.Team Leader & Organization InformationName of Church or Group Represented* Team Leaders Name* First Last Team Leaders Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Team Leader Work PhoneTeam Leader Cell Phone*Team Leader Email* Is the organization contact different than the team leader?* Yes No Organization Contact Person* First Last Contact Person Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Contact Person Work Phone*Contact Person Cell Phone*Contact Person Email* Areas of service interest*List the areas you expect your team may be able to serve based on the anticipated skills and abilities of your team members: Medical, Construction, Mechanical, Teaching, Sports, Computer-Business, Agriculture, and any other areas.
