Center for the Study of Eurasian
Nomads
Golden Hills Khazar Fortress
2158 Palomar Ave.
Ventura, CA 93001 USA
Phone: (805) 653-2607 * FAX: (805) 653-2607
e-mail: jkimball@csen.org
APPLICATION FOR
SUMMER 2004 EXPEDITION
GOLDEN HILLS KHAZAR FORTRESS
Minimum Age: 18 years
TAX DEDUCTIBLE CONTRIBUTION
If paid to CSEN
June 20-July 11, 2004
$1100.00
CONTRUBUTION DUE DATES
$300 due with application by April 20, 2004
Final contribution: $800 due by May 20, 2004
The essential official visa for the excavation
requires approximately four weeks to obtain.
Thus, deadlines are firm.
No Invitation for a Visa will be issued until
all contributions are 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 first 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______________________
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 _________________________________________________
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 Golden Hills 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, Golden Hills Khazar Fortress Excavation,
2158 Palomar Ave., Ventura, CA 93001, USA
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