Impact Trip Dominican Republic

Date

4 October 2025 - 11 October 2025

Register now

Title

Firstname *

Lastname *

Email *

Birthdate *

Phone

Mobile

Street *

Postal code *

City *

Passport name *

Your name as it appears on your passport.

Passport number *

Passport expiration date *

Emergency contact name *

Please let us know who we can contact in case of an emergency during the trip.

Emergency contact relation type

Emergency contact phone *

Share room with (other participant name)

I want a single room (extra fee)

Event

Fundraising objective

Comments

I accept the legal terms & the privacy policy conditions. *