Church/Group Name:

Name:
Street:
City:
State/Pr:	Alberta British Columbia Manitoba New Brunswick Newfoundland N.W.T. Nova Scotia Nunavut Ontario P.E.I. Quebec Saskatchewan Yukon Territory Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other
Zip/PC:
Phone #:
Denomination:

Contact Person: 

Name:
Home Phone:
Work Phone:
Email:

Dates: 2009 Summer Program

(Choose 1st, 2nd, and 3rd preference. Enter only 3 selections.)

1. June 7 - 13	1 2 3	2. June 14 - 20	1 2 3
3. June 21 - 27	1 2 3	4. June 28 - July 4	1 2 3
5. July 5 - 11	1 2 3	6. July 12 - 18	1 2 3
7. July 19 - 25	1 2 3	8. July 26 - Aug 1	1 2 3
9. Aug 2 - Aug 8	1 2 3	10. Aug 9 - 15	1 2 3

Non-Summer Dates - Sept 2008 to May 2009.

Note: Elkhorn, WV has year round availability.

Other sites are fall/spring only with limited availability.

(enter any preferred arrival and departure dates in Month day, Year format.)

Arrival:
Departure:

Group Size:

(Input number of each)

Adults:
Youths:

Preferred Work Location

Must select one. Note occupancy limits for each location.

Elkhorn, WV:	max 35
Eolia, KY:	max 15
Harlan, KY:	max 55
Letcher, KY:	max 22
Hindman, KY:	max 30

Specific skills that your group will bring to Appalachia:

Any tools or building materials your group may wish to donate:

Reminder: All participants are to be age 15 or older, unless accompanied during the week by their parent/legal guardian. MCC SWAP also requires one adult for every 5 youth.

Click submit to complete, wait for confirmation to appear, then close window to return to main web pages.

Submitting your application means you, the contact person, have read and accept the terms and procedures of the SWAP Group Application on behalf of your organization.