Project Amazon  Application:

Send a $100.00 nonrefundable deposit to reserve your place.  
Fees are due in full by 
May 1,   

Make checks payable to: Pleasant Valley Church (PVC)

NOTE: Please write Project Amazon in the Memo Line.  

Send application and deposit to: 

Pleasant Valley SDA Church 
 11125 SE 172nd Ave.
  Happy Valley, OR        
                          97086

Please print this page, fill it in, and mail to the sponsoring church listed in left column along with your deposit. Thank you!!

Name_______________________________________________ Date____________________

Address______________________________________________________________________

E-mail Address _________________________________Telephone (___)__________________

Age ______                                    Sex:      __ Male          __Female
  (Youth younger than age 18 are welcomed but please be accompanied by a parent or responsible adult. Thank you!)
 
T-Shirt Size   S   M   L   XL   XXL   Other __________

Food Preferences or Sensitivies/Allergies:____________________________________________
____________________________________________________________________________

Citizenship:    __USA                    __Other_______________________________      


Passport Number______________________________Expiration Date_____________________

Do you take medication?      __Yes         __No
If yes, what and How often?________________________________________________________
_____________________________________________________________________________

Please check any of the following skills that you have.

__English           __Spanish       __Portuguese    __Medical        __Nursing            __Dentistry     __Carpentry       __Masonry       __Cooking         __Music            __Worship           __Ornithology __Teaching Children (VBS)     
Other skills__________________________________________________________________