Please make certain that all required information is supplied. Double check all spelling.
Application: (check one):
initial application for 2009 season
revised application
Name:
First name
M.I.
Last Name or Surname
Suffix
Date of Birth:
Gender: Male
Female
Month
Day
Year
Title
Address:
Street
City
State
Zip/Postal Code
Country
E-mail:
FAX:
Phone Numbers:
Home
Cell
Work
Institutional Affiliation: (if applicable)
Application is for:
Individual
Family or Group
Total number (including yourself):
For each member in your family or group other than yourself, please supply the following information.
All these listed should be non-credit.
First Name
Last Name
Age
Gender
First Name
Last Name
Age
Gender
First Name
Last Name
Age
Gender
First Name
Last Name
Age
Gender
First Name
Last Name
Age
Gender
First Name
Last Name
Age
Gender
If there are more names in your group please submit an additional application with the remaining names.
Credit Desired for You: (Please submit a separate application for each person desiring credit or CEU's.)
Undergraduate lab science, GEOL 240, 4 hrs
Continuing Education Units
No credit
If undergraduate credit is desired, then a separate application to Southwestern Adventist University must be submitted.
Transportation:
to site
from site
SWAU transportation from Keene
SWAU transportation to Keene
Private vehicle
Private vehicle
Air to Rapid City, SD
Air from Rapid City, SD
Other:
Other:
Check the dates you are planning to arrive at the site and planning to depart (You only need to check these two dates—it is not necessary to check all the intermediate ones):
Dates for 2009 season: leave Keene 4 June, arrive at site 5 June — leave site 2 July, arrive back at Keene 3 July
June 2009
S
M
T
W
T
F
S
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
July 2009
S
M
T
W
T
F
S
1
2
Describe previous experience in field research, paleontogy, geology, or related activities:
Notes, comments, explanation, exceptions, or other information concerning your participation:
