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Technical Services Unit -Training and Consulting for the Sustainable Agriculture- Application of Sustainable Farms Tours (tours to sustainable farms) Dear Client: 1. Please complete this form, use the blank areas to fill in the information. Based on this information, we will create the tour according to your needs, profile and length of your stay in the country. To check the boxes place the cursor in the cell you want to mark and push the left mouse button. If you want to delete it, repeat the same action. 2. The information you provide is strictly confidential and it is used to prepare a quote and a proposal of itinerary as you need it. 3. Submit this form to Mayela Bonilla [email protected] or, [email protected] SECTION 1: CONTACT INFORMATION Name of contact person to coordinate the tour Position Phone Fax Name of individual or organization that will cover the costs of the tour Here. Phone Here. Fax Here. E-mail Here. Indicate the name for the invoice and details required Indicate the tentative date for the tour Indicate the number of participants Here. Here. Here. Cell phone E-mail Here. Here. Here. Here. Men: here. TOTAL: Women: here. Technical Services Unit Sustainable Landscapes Program SECTION 2: LOGISTICS DETAILS Please describe the purpose of your visit and expectations in relation to it. This allows us to prepare a package to suit your needs. For example: The focus of the tour is focusing on technical compliance with the Standard of Sustainable Agriculture Sustainable Agriculture Network. The focus of the tour is to meet the overall level of product and process of sustainable practices. The focus of the tour is to combine any of the previous two packages. (Check here): Product of interest: Coffee Cocoa Pineapple Banana Other: Duration of the tour: Enter the number of days available for farm visits: Check here Do you want to include additional days for tourism? How many? ______________ Indicate your preference: Beach Mountain Volcanoes Forrest ___________ days ___________ days ___________ days ___________ days Additional activities: Nature hikes White-water Rafting Zip Line Canopy River Floating Kayak mountain bike horseback-riding Other: Category hotel to stay: Three stars Four stars Five stars Please attach the information requested on the form template AG-PS-1005-S9 Profile registry of tour participants. AG-PS-S9-1001 Sustainable Agriculture, Rainforest Alliance 01/december/11 Page 2 of 3 Technical Services Unit Sustainable Landscapes Program SECTION 4: STATEMENT Through this application I declare that: We accept without reservation, Rainforest Alliance's decision regarding the processing of this application. The information in this application and attachments is true. Signed on behalf of (Name Organization / Client): Indicate here. Date Signed: Indicate here. Name of representative or authorized person: Indicate here. Signature of representative or authorized person: ________________________________ SECTION 5: FOR THE USE OF THE TECHNICAL SERVICES UNIT Name of RA representative that receives the request: Indicate here. Date of receipt of application: Indicate here. State of the application: Comments: Approved Denied Indicate here. AG-PS-S9-1001 Sustainable Agriculture, Rainforest Alliance 01/december/11 Page 3 of 3