Center for the Study of Eurasian Nomads
Dorno-Altai Excavation
2158 Palomar Ave.
Ventura, CA 93001 USA
Phone: (805) 653-2607 * FAX: (805) 653-2607
e-mail: jkimball@csen.org
APPLICATION FOR
SUMMER 2005 EXPEDITION
Alag Togoi Excavations
Applicant's Name _________________________________________
PROJECT DATES FOR VOLUNTEERS
TAX DEDUCTIBLE CONTRIBUTION PER SESSION
TAX DEDUCTABLE DONATION
Student: $1200
APPLICATION AND DEPOSIT OF $300 DUE NO LATER THAN
APRIL 15, 2004
FINAL CONTRIBUTION OF $ ($900 Student: $1100 Non-Student) DUE
NO LATER THAN JUNE 1, 2004
Note: The essential official visa for the
excavation requires approximately FIVE weeks to obtain.
A visa will not be granted until
the entire contribution is paid.
If you are not accepted, your deposit will be refunded.
If you are accepted and you withdraw more than 30 days before the
beginning of the first session, 50% of your deposit will be refunded.
If you withdraw after 30 days before the beginning of the first session,
no refund will be made. However, the deposit remains tax-deductible.
If the project is cancelled, your complete deposit will be refunded.
If you plan on staying in Mongolia longer than your
excavastion session, you must include this information on your application
so that the extra time can be included in your Visa. Visas for U.S.
residents will be obtained from the Mongolian Embassy in Washington
DC. After the invitation is sen to the Consulate the applicant should
send his/her Visa Application to the appropriate Embassy. Further information
is available at the Mongolian Embassy.
Length of Stay in Mongolia: Beginning Date ________________________
Ending Date _________________________
If you are applying from out of the United States,
please specify the Mongolian Consulate (or Embassy) where your Mongolian
Visa invitation should be sent. Provide the information below:
Mongolian Consulate
Street Address____________________________________________________________________________________________________________________________
City, County, Zip__________________________________________________________________________________________________
Telephone __________________________ FAX _____________________
Email ______________________________________________
Personal Information
Name_______________________________________________________________________________Birthdate______________________
Address__________________________________________________________________________________________________________
City _____________________________________________________________________________State
__________ Zip______________
Mailing Address if different from above_________________________________________________________________________________
________________________________________________________________________________________________________________
Home phone (_______) ________________Work or school phone ( ______)________________
Mobile_____________________________
E-mail address ________________________________________________ and
________________________________________________
We prefer to contact you by email, so if your email address changes
after you have submitted an application, please noify us.
Social Security number____________________________________________S
ex__________ Height_____________ Weight___________
Passport number___________________________________________ Expires_______________________________
Type______________
Include a xerox copy of the two front pages of your passport.
Employer or school_________________________________________________________________________________________________
Address of work or school___________________________________________________________________________________________
Phone number, work or school (________)______________________________________________________________________________
If retired, former employer ___________________________________________________________________________________________
Address _________________________________________________________________________________________________________
Please include a photograph of yourself in the application.
Emergency contact: Name____________________________________________________________Relationship______________________
Home address_____________________________________________________________________________________________________
Work address_____________________________________________________________________________________________________
Home Phone (______) _________________ Cell Phone (______) ______________________
Work Phone (_____) ___________________
e-mail____________________________________________________________________________________________________________
Special Interests
Please describe your special interest in this project, and what
experience you have had that might be helpful on this project. Attach
extra pages if necessary on a separate page, Please list all educational
background that is pertinent.
Previous Travel. On a separate page, briefly tell us about any previous
foreign travel, which countries you have visited and when.
PLEASE ATTACH CV and REFERENCES (important)
Medical Conditions
Medical treatment will not be equal to the norm in the US. Please be
sure to list all special medical conditions you may have.
________________________________________________________________________________________________
Blood Type___________ Diabetes____________ Epilepsy_______________
Allergies___________________________________________
Special Diet or Foods_______________________________________________________________________________________________
Other health concerns, such as bad back, trick knee, etc. (give details__________________________________________________________
________________________________________________________________________________________________________________
Loss of Consciousness (explain and give date(s)__________________________________________________________________________
________________________________________________________________________________________________________________
Check if Correctiv Lenses (______) or Contact Lenses (______) Date
of last physical examination___________________________________
Any other pertinent information: _______________________________________________________________________________________
________________________________________________________________________________________________
Conditions
As a team member (hereafter Participant) of
the Baga Gazaryn Chuluu Survey project, I will adhere to the regulations
and maintain a standard of good conduct. The Center for the Study of
Eurasian Nomads (hereafter Sponsor) and director of the excavations
(hereafter Director) reserves the right to require a Participant to
withdraw at any time if conduct or behavior jeopardizes the welfare
of any participant or the fulfillment of the objectives of the project.
Additional travel costs due to early dismissal will be the entire responsibility
of the Participant. It is understood that the Participant will assume
all responsibilities, financially or otherwise, for any illness or injury
which might occur during the expedition. Emergency transport, medical
or hospitalization costs resulting from illness or accident during the
expedition are the responsibility of the Participant receiving such
care. In cases where the Director, in consultation with the Participant
and local medical authorities, considers it necessary, a Participant
will be sent home or hospitalized. The Director will make every effort
to ensure that an ill or injured volunteer receives proper medical attention.
The Participant is aware that while taking part in this project, certain
exposure to risks may occur. Exposure may include but not be limited
to: accident and/or sickness without readily available medical facilities,
the forces of nature, travel on the ground and in the air, and others.
In consideration of the right for the Participant to engage in this
project, he or she assumes all of the risks involved and agrees to indemnify
and hold the Sponsor and the Director of the project and his Associations
harmless for any and all liability that may arise in connection with
travel to and from the archeological site, to any of the excursions,
and while engaged in any activities. I have read and fully understand
and accept the conditions for participating in this archaeological expedition.
Signature_________________________________________________________________________________________
Print name_________________________________________________________________Date___________________
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