EIU Alternative Spring Break '19- USA sites Application
PLEASE READ CAREFULLY:
* Complete the following application, and return it to the Student Volunteer Center, 500 Roosevelt Ave.
* $25 Non-Refundable Deposit MUST be turned in with your application. Total ASB fee is $200.
* Apply by Dec. 10th, 2018 & pay ONLY $150; Apply by Feb. 1st, 2019 & pay ONLY $175; Apply by Feb. 18th, 2019 & pay $200
* Balance due on Feb. 20th, 2019 - A cancellation for any reason after March 1st forfeits $75 plus deposit: -$100 total.
* What is included? Send off dinner, transportation, site fees, housing, meals on site, and a T-shirt.
* Make checks payable to: 'Newman Catholic Center', with 'ASB' on the memo line.
Name: First, Middle Initial, and Last *
Your answer
Gender: *
Birth Date (mm/dd/yr): *
Your answer
Age *
Your answer
Phone # *
Your answer
Charleston Address: *
Your answer
Email *
Your answer
Major (and minor): *
Your answer
Classification: *
If you are 21 or over, would you help us with driving?
If so: Drivers License #:
Your answer
Expiration Date of license: (mm/dd/yr)
Your answer
T-shirt Size: *
Home Address: *
Your answer
Home Phone: *
Your answer
Religious Affiliation:
Your answer
Home Church:
Your answer
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