CENTER FOR THE STUDY OF EURASIAN NOMADS

Volunteer Application Form

May also be requested by e-mail:

jkimball@csen.org

Return to Chastiye Kurgany Information Page

____________________________________________________

SUMMER 2001 EXPEDITION to the

CHATIYE KURGANS, SOUTHERN RUSSIA

SESSIONS

 

All questions should be addressed to:

jkimball@csen.org

Tele: (805) 653-2607

 

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.

RETURN TO CHASTIYE KURGANY INFORMATION PAGE

_____________________________________________________________________

Please check the session(s) in which you are making application for:

Session 1: July 14-July 28, 2001 (First choice____) (Second choice ____)

Session 2: August 1-August 15, 2001 (First choice____) (Second choice ____)

 

Personal Information

Name_______________________________________________________Birthday___________

Address_______________________________________________________________________

______________________________________________________________________________

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 __________________________________________________________

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 address___________________________

• PLEASE ATTACH CV and REFERENCES.

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:

 

As a team member (hereafter Participant) of the Chastiye Kurgans 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 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_____________

 

If the applicant is under 18, the signature of a parent or guardian is required.

 

Signature of parent or guardian __________________________________________________________

Print name of parent or guardian _________________________________________Date_____________

 

Please send application packet to:

Center for the Study of Eurasian Nomads

Chastiye Kurgans Excavations

577 San Clemente Street, Ventura, CA 93001

Phone: (805) 653-2607 * FAX: (805) 653-2607 * e-mail: jkimball@csen.org