Another Way Registration Form

Another Way Global Registration:
Full Name - as it appears on your passport*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
Date of Birth*

MonthDayYear
Date
Passport Number*
Another Way 2024 Cohort?*
Share briefly why you want to take part in a cohort and what you hope to gain?
Have you traveled internationally, and if so, where and for why?
Please give 2 references with email: A pastor/spiritual leader and a friend:

Trip Payment 1

Another Way Deposit Product Image

Another Way Deposit

$207.00 Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Payment plan:
*PAYMENTS MUST BE MADE ON TIME
$200 non-refundable deposit to confirm your spot on the trip. Turn in with application.
Flight cost due by 30 days from purchase
Balance of trip by March 30
Additional Costs:
Visa to enter Uganda: $50
Shots and malaria meds: pending each person’s insurance, etc.
Spending money: minimum $50
Travel Insurance as desired (info to come)
Payments using credit/debit have an automatic 3.9% processing fee (by the processing company not AW)
Signature*

Clear
Should be Empty: