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Study Tour of China Application - March 17-23, 2013

First Name*
Last Name*
Name on Badge*
Title/Position*
Company*
Address*
City*
State*
ZIP/Postal Code*
Email*
Business Phone*
Mobile Phone*
Home Phone*
Citizenship*
Date of Birth*
Passport Number*
Your Gender*Male
Female
Identify your Rooming Preference*Single Occupancy (est. $6000)
Double Occupancy (if available, est. $5500)
Name of your roommate, if known
Smoking Preference*Non-smoking
Smoking
Identify any health issues we should be aware of and/or any special accommodations that we should make
Emergency Notification - Name*
Emergency Notification - Address*
Emergency Notification - Day Phone*
Emergency Notification - Evening Phone*
Comments

Upon receipt of your application, you will receive confirmation of your application and an invoice for your program fee within 10 business days.

Application deadline is Thursday, November 15, 2012.

Cancellations after November 15, 2012 will be assessed a $500 cancellation fee.

Space for this program is limited.

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