Registration for SUNY Plattsburg
Costa Rica Community Service Projcet
January 3 – 14, 2017

Please fill out a separate registration for each traveler

First Name as it appears on passport (required)

Middle Name as it appears on passport (if applicable)

Last Name as it appears on passport (required)

Passport Number

Country of Issue (required)

Passport Issue date

Passport Expiry date

Date of Birth (required)

Country of Birth (required)

Mailing Address (required)

City (required)

State/Province (required)

ZIP/Postal Code (required)

Telephone (required)

Your Email (required)

I am: FemaleMale

I want a (required): Single RoomDouble RoomTriple Room

(Optional) My roommate(s) will be:

If you have any special requests, such as a special diet or physical limitations, please describe them below...

Optional Message

I understand that RMC highly recommends the purchase of Trip Cancellation Insurance, and our preferred Insurance provider is Allianz.

(required) I understand and accept the Terms and Conditions for this program.
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After clicking, please wait to be re-directed to another page with details about payment.