NEPAL TRAVELER REGISTRATION FORM

To register for the Oct 27 - Nov 11 trip to Nepal, submit this secure request or print it out and deliver it to a CDWT representative. Your registration is not complete until you also make a non-refundable $250 deposit by online payment or by check, payable to Clean Drinking Water Team Inc. We will send you an email confirmation when your registration is complete.

TRAVELER INFORMATION

Name:
Nationality:
Passport Number:
Passport Exp Date:
Date of Birth:
Country of Birth:
Address:
City:
State:
Zip:
Phone:
Email Address: