Tilmelding * Enrolment * Inscription * GRAND CANYON

TILMELDINGSFORMULAR * ENROLMENT FORM * FICHE D'INSCRIPTION

	Conservation work Grand Canyon/California

Date:
First name:
Last name:
Full address:
Country:
Telephone:
E-mail:
Nationality:
Occupation:
Education:
Birth date:
Passport number:

Do you smoke?	yes
	no

T-shirt size	small (S)
	medium (M)
	large (L)

Are you under any medical treatment, if yes, please specify!	i.e. epilepsy, diabetes, weak/irregular heart, asthma, knee or back injury etc.

Have you suffered any injuries or other condi-tions in the past 5 years?	yes no

Please describe any knee injury, or any other con-dition such as weak/ irregular hart, diabetes epilepsy, asthma etc. that you have suffered from in the past.

Are you vegetarian or vegan?	yes
	no

Grand Canyon program only
	8 weeks
	12 weeks
	5 weeks from 8th Nov.
	11 weeks from 27th Sept.
ACE Ocean program only
	12 weeks ACE Ocean only
Combination Grand Canyon & ACE Ocean	12 weeks (6 weeks each, Arizona first)
Arrival date:


Who to contact in case of emergency (i.e. parents):

Names:

Address:

Telephone:

E-mail:

Comments:

How did you find Exis?

		I understand the following important points: I will not be paid to participate in the eco-projects. The airfare and travel to the commencement point in Flagstaff, AZ or San Francisco, CA is not included. Costs include food, hostel-style accommodation, and project related transport. I will not be able to choose the exact projects I work on - but ACE will make every effort to assign me to projects that I am interested in. I have personal medical insurance (you are also advised to have travel insurance for personal items while in America). Drugs and alcohol are not permitted. I agree that I have read all of the information contained within this application. All of the information that I have provided is both accurate and complete.