ONLINE APPLICATION FORM

All fields are REQUIRED!
First Name:
Last Name:
Nickname:

Permanent Address:
Country of Residence:
Nationality:
Passport #:
Phone:
Email:
Date of Birth:


How did you hear about Peru Rocks?

Who are you? Tell us about yourself.
(200 words or less)

Why do you wish to take part in this event?
(200 words or less)
How do you intend to raise the funds required for your donation? (individual donations, corporate donation, personal donation, events – please be as specific as possible)

Do you have any special skills that we should be aware of that might be beneficial during the planning and/or execution of Peru Rocks?
Are you aware that the trip will require physical activity?
Are you physically capable to do the trek?




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