-
Name_____________________________________________________Birthdate______________________
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Address________________________________________________________________________________
-
City ____________________________________________________________State
______ Zip_________
-
Mailing Address
if different from above_______________________________________________________
-
Home phone (_____)
______________Work or school phone ( ___)___________ Mobile_______________
-
e-mail address
_______________________________________ and ________________________________
-
Social Security
number_________________________Sex________ Height__________
Weight___________
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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__________________________________________________________________________________
We prefer to contact you by email, so if your email address
changes after you have submitted an application, please noify
us.
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.You must bring any
prescription or over the counter medications hat you require.
LIST ANY MEDICAL
CONDITION THAT YOU HAVE OR HAVE HAD IN THE PAST FIVE YEARS
Blood Type___________
Special Diet or Foods__________________________________________________________________________________
If you dietary requirements
are different than noted in the information provided on the
Web pages associated with this application, you should plan
on bringing any required (or desired) foods.
Check any of the following that are applicable:
Diabetes________
Epilepsy__________ Allergies________________________________________________________________________________
Other health concerns, such as bad back, trick knee, etc. (give
details_________________________________________________
_______________________________________________________________________________________
Loss of Consciousness
(explain and give date(s)_________________________________________________________________________________
_______________________________________________________________________________________
Check if Corrective
(____) 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 archaeological or other activities.
I have read and fully understand and accept the conditions
for participating in this archaeological expedition.
Signature____________________________________________________________________
Print name_________________________________________________Date___________________
