August 2026 Participant Information
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Email *
Legal Name (First and Last) *
Address & Phone Number *
Please indicate which of the following most accurately describes you. *
Date of Birth
MM
/
DD
/
YYYY
Passport Status
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*IF* you have your passport, please provide the following:
Passport Number
Passport Date of Issue
Passport Date of Expiration
If you await your passport's arrival, please provide these to Shaye as soon as it arrives.
Have you ever been convicted of a felony?  If yes, please give short explanation. This will be required for our visa application.
Emergency Contact (Name, relationship, phone number)
Do you (or will you possibly) need a donation link and QR code to give to potential donors? *
You will be required to provide 2 things to Shaye for the visa application via email.  Please make note of them below.
Do you have any medical issues, concerns or even dietary restrictions that should be disclosed to the team leader?  If yes, please explain. *
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