CENTER FOR THE STUDY OF EURASIAN NOMADS
Volunteer Application Form
(May also be requested by mail from the address below)
SUMMER 2000 EXPEDITION to EGIIN GOL, MONGOLIA
$300 due with application by March 15, 2000
$1200 due on or before May 1, 2000
$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.
Mailing Address if different from above______________________________________________
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 __________________________________________________________
Please include a photograph of yourself in the application.
Relationship___________________ Home Address_____________________________________
Home Phone(_____) _____________ Cell Phone(______) ______________________
Work Phone(_____) ____________ E-mail address___________________________
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:
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.
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:firstname.lastname@example.org