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Airline & Medical Information

The information provided on this form is extremely important. It is used to purchase airline tickets and is also used in the event of a medical emergency. Please fill it out as accurately as possible.

 
If you provide Shirts Across America with inaccurate information, you may incur additional airline ticketing costs/charges.

Volunteer Information
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First Name
Last Name
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Email where you would like to receive confirmation of submission.
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(mm/dd/yyyy)
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Medical Information
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We will pass all dietary restrictions/information to the kitchen staff at our partnering accommodations, but not all dietary restrictions are able to be accommodated. Individuals with less common or multiple dietary restrictions should plan to pack or buy supplemental food while in New Orleans.
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Emergency Contact
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First Name
Last Name
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First Name
Last Name
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Helpful information includes location of travel, additional contact information if destination is abroad, etc.
Medical Insurance Card
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