Fund for Reconciliation and Development
64 Jean Court, Riverhead, NY 11901
director@ffrd.org
917-859-9025
June July 2020
(25th Anniversary of Diplomatic Relations)
Program
in Viet Nam, Cambodia and Laos
(subject to Corona Virus restrictions on travel)
Bracketed [Dates] are self-organized.
After completing the form for each traveler, click on "submit" at the end.
If you have any difficulty, or do not receive a confirmation,
be sure you have the latest version of Adobe Acrobat in your computer.
Personal itinerary (Please check as applicable.):
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Viet Nam June 24-July 10
Ha Long Bay extension July 11-12
Laos (Vientiane, Luang Prabang or Xien Quang) July 13-14 (subject to interest)
Cambodia (Phnom Penh, Angkor Wat) July 15-18 (subject to interest)
[Considering pre-program tourism in Ha Noi or Sa Pa]
[Considering post-program tourism to Sa Pa]
Other
Estimated date of Vietnam entry and departure
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Name as on passport
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First Name
Last Name
Country of issue
*
Date of expiration
*
Birth place
*
Date of birth (month/day/year)
*
Gender
*
male
female
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Emergency US contact, phone number, and relationship
*
Room preference:
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single
double
If double, name of person sharing:
Occupation, employer, position/title (former primary work, if retired):
If you have previously been in Indochina, approximately when:
Primary personal and/or professional goals for this trip:
Optional: Special skills for cultural exchange opportunities:
Optional: Please describe your involvement in the movement against the war in Indochina (for sharing with the group and with hosts).
Optional: Please summarize your work and social/political activism since the anti-war movement (for sharing with the group and with hosts)
Special medical and dietary requirements
Comments, questions, itinerary suggestions, requests for counterpart introductions, etc.:
To serve as a confirmation of interest , I am making by May 15th a contribution of $250 to the Fund for Reconciliation and Development here https://donorbox.org/fund-for-reconciliation-and-development [The contribution is 50% refundable if you need to withdraw before May 15th of 100% if delayed by corona virus.] For latest information on itinerary and cost, go here https://vnpea cecomm.blogspot.com/2020/01/indochina-trip-april-may-2019-45th.html .
*
already done
will do by May 15th
sending by mail to FFRD, 64 Jean Court, Riverhead, NY 11901
Other
When will you send as a scanned attachment the data/picture page from your passport (to director@ffrd.org)?
*
today
within a few days
Legal caveats (please check off to confirm):
I acknowledge that the Fund for Reconciliation and Development is facilitating my trip but is not a travel agent and is not legally or financially liable.
I have health insurance that will cover me or I will purchase travel insurance with health coverage.
After booking international flights, I will e-mail my itinerary to director@ffrd.org
Submit
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