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