Fund for Reconciliation and Development
64 Jean Court, Riverhead, NY 11901
director@ffrd.org
917-859-9025
March 2018 (50th Anniversary of My Lai)
Program for Veterans of the Anti-War Movement
in Viet Nam, Cambodia and Laos (and family / friends)
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:
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[Bangkok]
[Ha Long Bay -- recommend arrival in Hanoi by March 8]
[Sa Pa -- recommend arrival in Hanoi by March 8]
[Extra personal time in Ha Noi]
Viet Nam March 11 - 24
Cambodia (Phnom Penh, Angkor Wat) March 25 - 28 (subject to interest)
Laos (Vientiane, Luang Prabang or Xien Quang) March 29 - 31 (subject to interest)
Not yet certain other than Viet Nam
Other
Estimated date of Vietnam entry and departure
Name as on passport
*
Country of issue
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Date of expiration
*
Birth place
*
Date of birth (month/day/year)
*
Gender
*
male
female
Current mailing address
*
Phone number(s)
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e-mail address
*
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 visited Indochina, approximately when:
Primary personal and/or professional goals for this trip:
Optional: Special skills for cultural exchange opportunities:
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 December 15 a contribution of $200 to the Fund for Reconciliation and Development here http://tinyurl.com/donateffrd [Please insert "IC” in the space below “Designate your donation to a specific program or fund”. ] The contribution is 50% refundable if you need to withdraw before February 15th.) For latest information on itinerary and cost, go here https://tinyurl.com/ICtrip2018.
*
already done
will do by January 21
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
Submit
Should be Empty: