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Spring Break Build Registration

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First Name: *

Middle Name: *

Last Name: *

PLNU ID:

Address: *

PLNU Dorm (if applicable):

City: *

State: *

Zip: *

Cell Phone: *

Home Phone: *

Preferred Email: *

Secondary Email:

T-Shirt Size: *

XXL

Other...

Gender: *

Male

Female

Relationship to PLNU: *

Student

Staff

Faculty

Administration

Alumni

Other...

Do you have a passport?: *

Yes

If yes, expiration date:

Passport Number:

Date of birth: *

Citizenship: *

If not U.S., what country?:

Under Spanish proficiency the rating is from 1-5 with 5 being fluent in Spanish

Spanish Proficiency: *

Construction Experience:

i.e. roofing, plumbing, electrical, tile, electrical, etc

Work Preference

While the construction process we are using is very easy to learn and is designed for all levels of expertise/ability, we would like to know your work preferences and/or physical limitations.

Preferences:

I can do heavy lifting (i.e. work with cement).

I am only able to do moderate lifting.

I would prefer jobs that require little to no lifting.

Please describe any physical ailments/ limitations we should know about for the trip:

Lazarian Experience

Please explain any prior experience you have, if any, with Lazarian World Homes. Please include the location, year, and type of project you assisted.

Lazarian Experience:

If Lazarian experienced, are you willing to be a crew leader?:

Yes

Housing Choice: *

I will stay at the local hotel where other PLNU members will stay

I will make my own hotel reservations.

PLNU will provide all transportation, including any transport to and from hotels.

Family Member Participation

Check the box below if you are attending the trip with a family member but are not participating in the build.

Family Member:

I am attending the trip with a family member but not participating in the build.

Emergency Contact Information

Contact 1 Name: *

Contact 1 Cell: *

Contact 1 Home Phone: *

Contact 1 Email: *

Contact 2 Name: *

Contact 2 Cell: *

Contact 2 Home Phone: *

Contact 2 Email: *

Medical Information (for any of the following if none, list "NA")

Health Insurance Provider: *

Plan/ Group Number: *

Doctor's Name : *

Doctor's Phone : *

Current Medications : *

Medical Conditions : *

Allergies : *

Current Tetanus Shot: *

Yes

Other...

Additional Comments/ Questions:

The Build technically ends on Saturday, March 9 - but you are allowed to stay Saturday night to attend the dedication service on Sunday, March 10. Please mark your return date preference.: *

Saturday, March 9

Sunday, March 10

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News

Melissa Tucker's article on Mexico/USA co-nourishment is published on the Engage magazine
Nazarenes from USA-Mexico border region meet to talk about immigration and the Church

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