Tilmelding * Enrolment * Inscription * GRAND CANYON

TILMELDINGSFORMULAR * ENROLMENT FORM * FICHE D'INSCRIPTION

	Conservation work Grand Canyon or 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 (Arizona) program
	8 weeks
	9 weeks
	11 weeks
	12 weeks
ACE Ocean (California) program
	12 weeks ACE Ocean

When do you want to travel?
Insurance?	Do you want EXIS to provide travel insurance?
	yes
	no

Whom 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.


			Please mail a CV and letter of motivation in English to info@exis.dk