Registration Form: Carlsbad Sister City Youth Ambassador Exchange Program
June 15-24, 2020
Participant Passport Information
* All information must be as same as the valid passport.
* If you do not have a passport, please skip to the next question.
First and Middle Name (Given names)
Your answer
Last Name (Surname)
Your answer
Date of Birth
MM
/
DD
/
YYYY
Title (Student, Chaperone, or Teacher)
E-mail Address
Your answer
Phone Number
Your answer
Mailing Address (Street)
Your answer
Mailing Address (City)
Your answer
Mailing Address (Zip Code)
Your answer
Name of Parent or Guardian
Your answer
Parent or Guardian (E-mail Address)
Your answer
Parent or Guardian (Phone Number)
Your answer
Relationship to participant
Your answer
Emergency Contact (if different than above)
Your answer
Emergency Contact (Phone Number)
Your answer
Relationship to participant
Your answer
Diet Request and Allergy
List of Allergies
Your answer
Known Medical Conditions
Your answer
Thank you. An e-mail confirmation will send out within 24 hours after submission. For any questions, please contact us at info@asiagetaway.com.
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