Registration Form

ECO CUBA NETWORK TRIP

Choose one trip from the drop down menu.

PASSPORT INFORMATION

PARTICIPANT INFORMATION


OCCUPATION AND INTERESTS

Work pertaining to environmental protection and sustainable development
Your affiliations in terms of environmental protection and sustainable development

QUESTIONS ON THIS CUBA TRIP

IN CUBA/ROOMMATES

If you prefer a double room, and you already have a roommate, please let us know your roommate's name.
If you prefer a double room, and you do not have a roommate, we will be happy to find a compatible roommate for you from among the participants, if possible.

IN CUBA/SPECIAL INTERESTS AND NEEDS

Do you have particular professional interests while in Cuba? Are there particular aspects of the fields being studied that are of most interest to you? Particular Cuban organizations or Cuban professionals you would like to visit or meet with?
Do you have any health or dietary needs that we should be aware of?

EMERGENCY CONTACTS

HEALTH INSURANCE

Please let us know the name of your health insurance agency and account number.