Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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How will you spread the word about Help Chiapas and the community we serve? *

After your trip, in what ways are you willing to share your experiences with friends and family members to help the community we support and love? Please select all that apply

Host a house party or gathering

Volunteer at an event

Fundraising

Grant writing and/or Research

Photography

Videography

Tech Support

Marketing/Communications

Other (please list in additional notes section below)