Gender |
|
|
Title |
(Mr. Mrs. Ms.)
|
|
First Name
(Given
Name) |
(As it appears on your passport.) |
|
Last Name
(Family Name) |
(As it appears on your passport.) |
Badge Name |
(Name to be printed on your badge,
20 Characters maximum.) |
|
E-mail |
|
| Confirm your E-mail |
|
|
Street Address |
|
|
City |
|
|
State or Province |
Postal Code
|
|
Country of Residence |
(Mailing address.) |
|
Country Issuing Passport |
|
|
Passport Number |
|
|
Passport
Expiration Date |
month
day
year
Make sure your Passort is NOT expired. |
|
Birthdate |
month
day
year
|
Language |
If you can speak English fluently, select English.
Otherwise
select
your preferred primary language. |
| |
Food Requirement |
|
Press Information |
Name of Organization,
Agency, or Publication |
|
Telephone # |
Fax #
|
| |
|
Website URL |
|
Type of Publication |
|
Circulation |
(Daily, Weekly, Monthly, etc.)
|
Emergency Contact and
Medical Information |
Enter the name and contact information for an emergency contact person. |
Name:
Relationship:
Contact Phone:
Alternate Phone:
Contact E-mail:
|
|
| If you have any medical conditions or allergies we should be aware of, please describe them here |
|
|
|
If you have been invited by Recuiter,
Please enter the his or her name here:
|
Optional Programs |
|
Check here if you are interested in observing would like to observe the International Marriage Blessing ceremony. |
|
Check
here if you are interested in observing the Mister and Miss University International Beauty Pagent. |
|
Check
here if you are interested in joining the international volunteer
service project. |