"APPLICATION OMETEPE ARCHAEOLOGICAL PROJECT Please fill out completely Use"
APPLICATION OMETEPE ARCHAEOLOGICAL PROJECT, 2009 (Please fill out completely. Use a continuation sheet if necessary.) Send to: Suzanne Baker/Culturelink 609 Aileen St. Oakland, California 94609 firstname.lastname@example.org ----------------------------------------------------------------- Name: Address: Tel. Fax E-Mail Age: Two Emergency Contacts (name, address, telephone): 1. 2. Passport Information (Note: You must have a passport valid for at least 6 months after your scheduled return to the U.S. If you are not a U.S. citizen, you must contact the Nicaraguan Consulate for visa information): Number: Country: Place of Issue: Date of Issue: Expiration Date: Previous Archaeological Experience (Survey, excavation, petroglyph recording, etc.) (if extensive, please include a resume): Related Experience: 1 Spanish ability (circle one): Fluent Can Communicate Bare Survival None Why do you want to participate in this project? Discuss previous travel experience. Have you ever been to Nicaragua, Central America, other Latin American countries before? Do you have any health problems that might cause difficulties in a strenuous, hot situation (allergies, chronic illness, disabilities or minor ailments)? Do you take any prescription medicines or over-the- counter medicines regularly? Please discuss: Blood type Date of last physical Date of most recent inoculations: polio booster tetanus booster Do you have any special dietary needs? We cannot guarantee that vegetarian dietary needs can be met. Will this be acceptable? Have you lived and worked in a group situation before? Tell us something about yourself. 2 Duration of Stay (Check one) ___ I plan to stay the whole 3 weeks of the project. ___ I plan to stay __2__ weeks, from January 10 to January 24, 2009. Statement of Agreement I have filled out this application completely and honestly. I understand that if I am accepted for this project I will be living and working in Nicaragua as a member of a group under difficult conditions. I agree to respect the decisions of the project leaders. I understand my financial obligations for the project and agree to submit the required fees by the date determined. I understand the basic rules: 1) No bringing or handling of firearms under ANY circumstances; 2) no physical or verbal violence to other group members or Nicaraguans; 3) no use of illegal drugs. I agree that violation of these basic rules may result in dismissal from the project. Signature of Applicant____________________________________ Date___________________ Please remit your $25 deposit made out to Culturelink And send with application to: Culturelink, 609 Aileen St., Oakland, CA 94609 Culturelink Fieldwork Project http://culturelink.info The Ometepe Petroglyph Project 3