First name

Last name

Date of birth

Age

Gender

Female Male Non-binary

Nationality (by passport)

Country of residence

Street address

City

Province / State

Postal Code / ZIP Code

Phone(s) (incl. country and area code)

E-mail

Current occupation

Employer / Educational institution / Other

Languages spoken

Health problems

Emergency contact

Emergency phone and/or e-mail

Volunteer experience

Project choice 1

Project choice 2

Project choice 3

Project choice 4

Project choice 5

Project choice 6

I want to be placed together with my friend

Remarks

Your motivation to volunteer in the chosen project(s)

Financial contribution

$495 (project & membership) $440 (project for members) $935 (two projects & membership) $880 (two projects for members) $1375 (three projects & membership) $1320 (three projects for members) $1815 (four projects & membership) $1760 (four projects for members) $130 (change of placement)

Please, choose your method of payment

I will mail a cheque I will pay by Credit card

Credit card details

Visa

MasterCard

AmericanExpress

Name of cardholder

Billing address

Credit Card Number

Expiration date (mm/yy)

CVV (Card Security Code)

I acknowledge and accept CADIP Terms and conditions for participation in a volunteer project (please, note that without this confirmation your request can not be proceeded)

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