Hi! I'm Barbara and I would love to answer your questions and talk to you more about traveling to India with The Miracle Foundation. Please fill out the information and application below and I will contact you.

Name as it appears in Passport*

Which tour are you interested in?*

Medical Trip-10 days, Oct 22-31, 2010 - Medical Professionals Only The Lullaby - 10 days, March 2011 The Lullaby - 10 days, October 2011 Medical Trip - 10 days, October 2011 Not sure, I would like more information

E-mail

Home Phone*

Cell Phone*

Street Address*

City, State, Zip, Country*

Work Phone

Date of birth*

Why do you want to go on this trip?

Describe any previous experiences that have influenced your decisions to make this trip.

What do you hope to achieve from this experience?

What are your special skills, talents, and/or hobbies?

I understand that I will be asked to do tasks while I am visiting the children and I commit to performing those tasks*

Yes

No

I would like to contribute my time in India focusing on the following activity:*

Computer related work Childcare and development Maintenance and building related work Gardening Photography Other (please specify below)

Specify "other"

I have been advised that I must apply for a tourist visa in order to travel to India. I understand that obtaining the Indian Visa is solely my responsibility. Detailed instructions about the Indian Visa is available in the travel section of the website at MiracleFoundation.org. Proof of valid Visa will be shown to the Travel Coordinator prior to travel from the USA.

I understand that I am responsible for my Indian Visa*

Yes

No

I have been advised that I may be required to receive inoculations prior to traveling to India. I can either receive these inoculations from my primary physician or from the physician recommended by The Miracle Foundation.

I have been advised that I may need inoculations*

Yes

No

I understand that travel insurance has been strongly recommended by The Miracle Foundation. I understand that any expenses incurred due to circumstances outside the control of The Miracle Foundation can sometimes be covered by travel expenses (medical expenses, costs incurred due to delayed or cancelled flights, etc.) and that options for this insurance can be found in the travel section of the website at MiracleFoundation.org.

I understand the above information about travel insurance and unforseen charges:*

Yes

No

I understand that if a tour does not have 10 people confirmed within 5 weeks of the scheduled travel date, the tour will be cancelled:*

Yes

No

I understand that travel arrangements such as flights, hotels, and trains are subject to change:*

Yes

No

I understand that a non-refundable travel deposit of $250 will be required within 2 weeks after acceptance of this application.*

Yes

No

I understand that under no circumstances is smoking is allowed at all at any of the orphanages, on orphanage grounds, and in front of TMF children and staff.*

Yes

No

I understand that there is no drinking allowed if under 21 years of age.*

Yes

No

Questions marked with * denote required information.