Register for Cuba Agroecology Tour - Organic Growers School

General Information

Name (as it appears on your passport)*

First Middle Last

Name (that you prefer to be called):*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone

Date of Birth*

Place of Birth*

City State / Province / Region Country

Occupation

If retired, please indicate your previous occupation.

Employer

Passport Information

I am a citizen of:*

Country

Passport Number:*

State where issued:*

State / Province / Region

Date of Issue:*

Date of Expiration:*

Emergency Contact Information

Name*

First Last

Relation

City/State

City State / Province / Region

Email*

Phone*

Contact Instructions

Language Abilities

Do you speak a language other than English?*

Yes
No

Language

Proficiency Level

Basic
Intermediate
Conversational
Fluent

Accommodations

Please mark your preferences. Tour price is based on double occupancy (which is not always guaranteed). Single room accommodations require an additional fee.

Please let us know your roommate preferences.*

Please assign me a roommate as necessary.
I would like to room with someone who is registering for the trip.
I would like a private room ($230 additional cost will be billed to you later.)

Name of desired roommate

First Last

Is there anything else we should know about you to best meet your needs and expectations?

We'd love to hear about why you're excited to go on the Agroecology Trip to Cuba!

Consider telling us about your interests and involvement in agriculture and what you hope to gain from the trip, as well as any concerns you might have.

Deposit Instructions

A $500 deposit is required to hold your spot for the trip. This deposit can be paid by check or using a credit card through this registration system.

I would like to pay my refundable deposit:*

Now, please charge my credit card ($500)
Using a check

Make check payable to Organic Growers School and send to the following address:
Organic Growers School
c/o Cuba Trip Organizer
PO Box 17804
Asheville, NC 28816

Remaining Fees

Please indicate how you would like to be billed for the remaining balance ($2,450). If you choose to pay in installments, we will contact you to work out the details of your payment schedule, to be completed by November 1, 2021. Any inquiries about payment options please contact rod@organicgrowersschool.org

I would like to pay:*

In full now ($2,450)
In installments.
I am a scholarship recipient and have made other payment arrangements.

Total

$0.00

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

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