Center for the Study of Eurasian Nomads
Chastiye Kurgans Excavations
2158 Palomar Ave.
Ventura, CA 93001 USA
Phone: (805) 653-2607 * FAX: (805) 653-2607
e-mail: jkimball@csen.org
APPLICATION FOR
SUMMER 2004 EXPEDITIONS
CHATIYE KURGANS, SOUTHERN RUSSIA
Minimum Age: 18 years
SESSION
TAX DEDUCTIBLE CONTRIBUTION
THREE-WEEK SESSION: $1100.00
CONTRUBUTION
DUE WITH APPLICATION: $300 BY
May 15, 2004
FINAL CONTRIBUTION: $800 DUE June 15, 2004
Note: The official excavation
visa requires approximately FOUR weeks to obtain. Thus, deadlines
are firm as an Invitation for the Visa will not be granted to the
applicant until the entire contribution is paid.
REFUND POLICY: If you are not accepted, your deposit will be refunded.
If you are accepted and you withdraw more than 60 days before the
beginning of the session, 50% of your deposit will be refunded.
If you withdraw after 60 days before the beginning of the first
session, no refund will be made. However, the deposit remains tax-deductible.
Personal Information
Name________________________________________Birthdate______________________
Address___________________________________________________________________
Mailing Address if different from
above ___________________________________________
Home phone (_____) ______________ e-mail address ___________________________
Social Security number_________________S ex_____ Height_______ Weight_______
Passport number_____________________________
Expires______________________
PLEASE INCLUDE A XEROX COPY OF THE
FIRST TWO 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
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_______________________________________________________
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 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 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_____________
Return Application to: Center for the Study of Eurasian Nomads,
Chastiy Kurgany Excavation, 2158 Palomar Ave., Ventura, CA 93001,
USA
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