HHART Registration Reminder: Send $250 initial deposit to steve@hhart.org once you have completed your registration. Company Which Mission would you like to join? (select all that apply) * HHART 18 (March 20-27, 2022) HHART 19 (March 27 to Apr 3rd, 2022) Your Contact Details First Name * Last Name * Email Address * Primary Phone * Alternative Phone Date of Birth (YYYY-MM-DD) * City * Province * – Select Province/State – Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Country * Occupation / Special Skills * Are you a member of Rotary? * No Yes, Rotarian Yes, Rotaractor Yes, Other If you are in Rotary, which club? Emergency Contact Information Name * Relationship * Main Phone * Alternative Phone T-Shirt Info Everyone will be issued two HHART t-shirts shortly after their arrival in the DR. These shirts are free and will clearly identify us as HHART/Rotary service mission members. They are of good quality, made of quick-dry material and are meant to be worn in the field. There is a ladies fit version, a traditional men’s style and a men’s sleeveless version available. For First Time HHART Members To obtain the best fit possible, lay your favourite loose-fitting working/activity t-shirt (i.e., not your form-fitting “wowza” T-shirt) flat on a table and measure the distance from arm-pit to arm-pit straight across the chest. Width of Favorite Shirt (For first time members only) T-Shirt #1 Size * XS S M L XL XXL XXXL XXXXL T-Shirt #1 Style * Woman's Cut T-Shirt Men's T-Shirt Men's Sleeveless T-Shirt #2 Size * XS S M L XL XXL XXXL XXXXL T-Shirt #2 Style * Woman's Cut T-Shirt Men's T-Shirt Men's Sleeveless Additional Information Tell us a little about yourself (100-120 words) For Example: HHART Chief of Operations is Steve Wallace. Steve planned this and all previous HHART missions and will guide your team safely through a service trip-of-a-lifetime. Steve is very familiar with the people and villages we will be serving. His experience as a mission planner and team leader was obtained through 24 years of service in the Canadian Air Force. Professionally, Steve is a commercial airline pilot. He is also a Rotarian and past- president of the Rotary Club of Wasaga Beach and past chairman of Rotary International District 7010’s Service Projects Committee. Steve resides in Wasaga Beach with his trusty dog, Buster. Please upload a passport style photo of yourself (JPG and PDF formats only) Please upload photo page of your passport,(JPG and PDF formats only) (required for booking your flight) Occupancy Options – The price of the mission is based on double occupancy. Single Occupancy ($175 Extra) Double Occupancy, 2 Double Beds (included in price) Double Occupancy, 1 King Bed (Included in price) Indicate name of preferred room-mate ( if applicable)
