Bethlehem Passport Request - Open Bethlehem

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USA TOUR 2017

Bethlehem Passport Information

Thank you again for your very generous support.

Please provide the following for each passport holder.

We will send your completed passports to you as soon as possible.

Title *

Name *

First

Last

Honours / Associations *

Role Title *

Occupation *

Gender *

Date of Birth (please enter as dd/mm/yyyy) *

Birth Town *

Birth Country *

Phone Number *

Email *

LinkedIn Profile *

Facebook Profile *

Twitter Proflle *

Address *

Line 1

Line 2

City

State

Zip Code

Country

What are you interested in helping with (tick all relevant)? *

Campaigning & Lobbying Community Outreach Events - Organising Events - Performing Events - Speaking Fundraising HQ Functions Marketing - Communications Marketing - Content Marketing - Design Marketing - Media Screenings - Hosting Screenings - Organising Screenings - Speaking / Q&A Supporter Engagement Other (Please specify below)

Other: *

Which geographic region/s are you able to help in? *

Are you happy for us to include you in our published list of Bethlehem Ambassadors? *

Yes No

Personal Statement - What inspires you to become a Bethlehem Ambassador? *

Additional Information: *

Please let us have any additional information that you think may be of interest regarding how you can support Open Bethlehem

Upload File Passport Photograph *

Max file size: 20MB

NB Your details will always be held securely and confidentially, and will not be shared with anyone without your prior permission.

Submit Passport Information

St Clement’s Eastcheap,
1 Clements Court,
Clements Lane,
London
EC4N 7HB

Phone:

+44 (0)203 725 3496

Email:

Ambassadors@OpenBethlehem.org

As an independent not for profit organisation we rely on donations, if you would like to support us please click here

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