BNEI AKIVA BOGRIM MISSION TO SOUTH CAROLINA WITH HABITAT FOR HUMANITY
First Name
Last Name
E-mail
Address
City
State	AL AK AR AZ CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Age
School
Grade
Tell us about your previous involvement in Bnei Akiva
Have you participated in Habitat for Humanity before?	No Yes, and with Bnei Akiva Yes, but with another group
Tell us why you want to participate in Bnei Akiva's Habitat for Humanity trip
Tell us why you would be an asset to this trip - skills, attributes, cooking ability, etc.
How do you feel about participating in manual labour and physical construction of a house?
What do you expect to get out of participating in this trip?
Do you have any dietary restrictions?
Do you have a Driver's License?	Yes No
If yes, would you feel comfortable driving a van with 10 people for an appropriate length of time as we travel to and from South Carolina?	Yes No
Anything else we should know? Perhaps some comments . . .