Please complete this form on your browser, print it, and sign it. Then mail it together with

  1. your $600 nonrefundable deposit (this includes your membership) 
  2. a color, high-resolution scan of the photo/signature page of your passport.
  3. the signed Release from Liability form

to:

The Friendship Association
P.O. Box 840011
Saint Augustine, FL 32080

Your Name - exactly as it appears on your passport

Date of birth

Place of birth

Mother's maiden name

Your Email

Your mailing address

Landline

Cell phone

Citizenship

Passport number

Passport expiration

Delegation departure date

Delegation return date

Emergency contact

Special needs (physical, dietary, health, psychological, spiritual)

Preferred accommodations (if available)

Have you been to Cuba before?
YesNo

Date of most recent visit to Cuba

Level of proficiency in Spanish

Brief Bio that includes your work, play, and your interest in Cuba

Signature __________________________________________

Date _______________________________________________