KHANUY VALLEY ARCHAEOLOGY PROJECT
- APPLICATION 2010 -


Sessions
        Please check box of the session you wish to attend

Session I - May 17 to June 8, 2010

Session II - June 8 to June 30, 2010



Applicant Information
Gender: Male Female
Your Name: Last: First: Middle:
Permanent Address:
City:
State/Province:    Country:    
Zip:
Home Phone:   Cell:
Email:
(We communicate essentially by email; please indicate if you
prefer to be contacted via the phone.)
Social Security Number:
Citizenship:
Date of Birth (month/day/year):
Place of Birth (city, state, country):
Passport Number:
Place of Issue:
Expiration Date:
Name of Home College or University:
(if applicable)
Major(s): Minor(s):


Who should be notified in case of emergency?
Name:
Address:
City:
State/Province:  Country:
Zip:
Home Phone:  Cell:
Work Phone:  Fax:
Email:
Relationship to you:


Reference (please provide one academic or professional reference)
Name:
Affiliation:
Address:
City:
State/Province:  Country:
Zip:
Home Phone:  Cell:
Work Phone:  Fax:
Email:
Relationship to you:


How did you hear about this Project?

     


Statement of Interest
      This statement should include a brief description of your interest in this project, and what experience you have had that might be helpful on this project. Please list all educational or professional background that is pertinent. Note, however, that participants need not have any special training or experience. Also, please briefly tell us about any previous foreign travel, which countries you have visited, when and how long.
     


Medical conditions
Medical treatment will not be equal to the norm in the US. Please be sure to list all special medical conditions you may have. You must bring any prescription or over the counter medications that you require.

LIST ANY MEDICAL CONDITION THAT YOU HAVE OR HAVE HAD IN THE PAST FIVE YEARS
Blood type:
  Special Diet or Foods:

If your dietary requirements are different than noted in the information provided on the Project Overview associated with this application, you should plan on bringing any required (or desired) foods.
Check any of the following that are applicable

Diabetes:   Epilepsy:   Allergies:

Other:
 Other health concerns, such as bad back, trick knee, etc. (give details)
 Loss of Consciousness (explain and give date(s))
 Any other pertinent information:


Conditions

        I have read the Project Overview, and have read all and/or agree to read all other materials sent to and received by me about the program for which I am applying, and feel informed.

As a team member (hereafter Participant) of the Khanuy Valley Archaeology Project, I will adhere to the regulations and maintain a standard of good conduct. The director of the expedition (hereafter Director) reserves the right to require a Participant to withdraw at any time if conduct or behavior jeopardizes the welfare of any participant or the fulfillment of the objectives of the project. Additional travel costs due to early dismissal will be the entire responsibility of the Participant. It is understood that the Participant will assume all responsibilities, financially or otherwise, for any illness or injury which might occur during the expedition. Emergency transport, medical or hospitalization costs resulting from illness or accident during the expedition are the responsibility of the Participant receiving such care. In cases where the Director, in consultation with the Participant and local medical authorities, considers it necessary, a Participant will be sent home or hospitalized. The Director will make every effort to ensure that an ill or injured volunteer receives proper medical attention. The Participant is aware that while taking part in this project, certain exposure to risks may occur. Exposure may include but not be limited to: accident and/or sickness without readily available medical facilities, the forces of nature, travel on the ground and in the air, and others. In consideration of the right for the Participant to engage in this project, he or she assumes all of the risks involved and agrees to indemnify and hold the Director of the project and his Associations harmless for any and all liability that may arise in connection with travel to and from the archaeological site, to any of the excursions, and while engaged in any archaeological or other activities.

I have read and fully understand and accept the conditions for participating in this archaeological expedition. I declare that all information provided in this form is true, complete and correct to the best of my knowledge.

By checking this box you are signing this document.

         You should receive an email acknowledging the receipt of your application within about 48 hours. If you do not receive this acknowledgement please email me at: jeh48@pitt.edu