2017 Outbound NTC Exchange Chaperon Application
Interested applicants to be Chaperons for the 2017 New Taipei City Student Exchange Trip
Last Name *
As shown on your Passpart
First Name *
As shown on your passport
Middle Name or Maiden Name
As shown on your passport
Male or Female? *
Association?
School, Organization, etc.
Title
Email *
Phone *
Hotel Occupancy
Single Occupancy will be an additional Cost!
Clear selection
Dietary Restrictions
Please specify!
T-Shirt Size *
US Sizes
Home Address *
City, State, Zipcode *
Date of Birth *
MM
/
DD
/
YYYY
Passport # *
Passport Expiration *
MM
/
DD
/
YYYY
Citizenship
Frequent Flyer #
Facebook ID
Will give you access to the Taiwanese Facebook
Allergies
List all allergies and medical conditions
List all medications
Emergency Contact
Name, 24-hour phone number
Submit
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