Programs

Lives That Matter - Application

This application form is used by the Lives that Matter team to assess your suitability for the course. Please take the time to fill out the form thoroughly.

Remember that this course is not available to everyone who requests it. We will only offer it to those who really want to create a life that matters. For this reason, you will need to be willing to do what it takes. You will need to be willing to let us work with you and support you.

Name
Date of Birth
Gender	Male Female
Nationality
Mailing Address
State (US Residents)
Post/Zip Code
Country
Phone (home)
Phone (work)
Fax
Email Address (Please Check)
Why do you want your life to matter?
How would you like to be remembered?
How would you like the Lives that Matter Program to help you?
Do you have any questions for us? Please state.
How did you locate our website?
Would you like to receive our monthly Newsletter?	Yes (html) Yes (plain text) No

Feature Fundraiser: Climb to Everest Base Camp

Our second feature fundraiser is planned for October 2005, when volunteers will have the opportunity to raise money for the Nepali Children's Fund. As a participant of this fundraising trek to The Base Camp of Mount Everest you will have the opportunity to visit ancient temples and palaces in Kathmandu. more >>

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