CENTER FOR THE STUDY OF EURASIAN NOMADS

Volunteer Application Form

(May also be requested by mail from the address below)

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SUMMER 2000 EXPEDITION to EGIIN GOL, MONGOLIA

$1500 donation

$300 due with application by March 15, 2000

$1200 due on or before May 1, 2000

 

$1100 donation

$300 due with application by April 15, 2000

$800 due on or before May 1, 2000]

 

These sessions are recommended as we expect the full research staff to be in the field during this time. Session schedules, possibly at a slight additional cost, may be negotiated in order to accommodate the needs of volunteers.

Please contact William Honeychurch if you have additional questions about summer scheduling.

If you are not accepted, your deposit will be refunded. If you are accepted and you withdraw 60 days before the beginning of the first session, 50% of your deposit will be refunded. If you withdraw 60 days or less after the beginning of the first session, no refund will be made. However, the deposit remains tax-deductible.

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Personal Information

Name_______________________________________________________Birthday___________

Address_______________________________________________________________________

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Mailing Address if different from above______________________________________________

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Home phone (_____) ______________ e-mail address ______________________________________

Sex_____ Height_____ Weight_____ Social Security Number________________________________

Passport Number_________________________________________ expires_________________

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_____________________________________

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Work Address__________________________________________________________________

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Home Phone(_____) _____________ Cell Phone(______) ______________________

Work Phone(_____) ____________ E-mail address___________________________

  • 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 separat page, briefly tell us about any previous foreign travel, which countries you have visited and when.

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___________ Special Diet or Foods____________________________________________________

Diabetes________ Epilepsy__________ Asthma__________Allergies__________________________________

Other health concerns, such as bad back, trick knee, etc. (give details)______________________________________

_______________________________________________________________________________________

Loss of Consciousness (explain and give date)_________________________________________________________

Corrective or Contact Lenses___________ Date of last physical examination___________________________

Any other pertinent information:

 

 

 

Conditions

As a team member of the Egiin Gol project, you must adhere to regulations and maintain a standard of good conduct. The sponsor reserves the right to require a partaicipant to withdraw at any time if conduct or behavior jeopardizes the welfare of the children or fulfillment of the objectives of the project. Additional travel costs due to early dismissal will be paid by the volunteer teacher. It is understood that the volunteer will assume all responsibility, either 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 volunteer receiving such care. In cases where the project leader, in consultation with the volunteer and local medical authorities, considers it necessary, a volunteer will be sent home or hospitalized. The project leader will make every effort to ensure that an ill or injured volunteer receives proper medical attention. The volunteer 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 volunteer to participate in this project, he or she assumes all of the risks involved and agrees to indemnify and hold the the project leader and the sponsors of the project harmless for any and all liability that may arise in connection with participation in the activities. I have read and fully understand and accept the conditions for participating as detailed above.

Signature_________________________________________________________________________

Print Name________________________________________________________Date_____________

 

Please send application packet to:

Center for the Study of Eurasian Nomads

Egiin Gol Project

1607 Walnut Street, Berkeley, CA 94709

Phone: (510) 549-3708 FAX: (510) 849-3138 E-mail:jkimball@csen.org