Which Delegation are you applying for?
Name
Address
City
State
Zip
Home Phone
Work Phone
Email
Emergency Contact (Name and Phone)
Passport Number Exp Country
Why do you want to work in solidarity with people in Mexico?
Do you belong to any organizations? If yes, please list them.
Please provide names, phone numbers, e-mail for three references that you have known at least one year:
Do you have any health problems that may affect your ability to travel?
Please remember to print out two copies of your submission and send it with a check or money order for $100 to reserve your space to the following address:
Mexico Solidarity Network c/o Delegations 4834 N. Springfield Chicago, Illinois 60625
Should you require further assistance or have questions concerning any of the delegations organized by MSN, please do not hesitate to call (773) 583-7728.
