Name: 

Address:     City:     State:  Country:

Phone:        E-Mail address:     Age:     Sex: 

What is your physical condition? poor good fantastic

Do you have any physical impairments that would prohibit or limit your work on the Farm? Explain

Please explain briefly why would you like to come to Malu 'Aina?

What dates would you like for your Malu 'Aina sojourn?

Do you have any experience in organic farming and/or social justice involvement? Explain.

Do you have any special needs? Medication?  Explain.

Please highlight one or two significant events/turning points in your journey of life.

What is your spiritual / social background?

Malu 'Aina Farm
Center for Non-Violent                                                                                   
Education and Action

PO Box AB
Ola'a, (Kurtistown) Hawaii 96760
(808) 966-7622