Register for Damascus Summer Encounter

Damascus Summer Encounter Registration form
Section I: General Information
General Information > Volunteer Assesment > Arabic Proficiency > Liability Form > Confirmation * denotes a required field
First Name *
Middle Name
Last Name *
[Note: Please type your full name, above, exactly as it appears on your passport]
Home Phone Number *
Mobile Phone Number
Work Phone Number
E-mail Address *
Mailing Address:
Street Address *
City *
State (U.S. Only)	Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code *
Country *	United States of America Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua & Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Azores Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Bosnia & Herzegovina Botswana Brazil British Indian Ocean Ter Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Chad Channel Islands Chile China Christmas Island Cocos Island Columbia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Ter Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guyana Haiti Hawaii Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea North Korea South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Midway Islands Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Nambia Nauru Nepal Netherland Antilles Netherlands Nevis New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norway Oman Pakistan Palau Island Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saipan Samoa Samoa American San Marino Sao Tome & Principe Saudi Arabia Senegal Serbia & Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka St Barthelemy St Eustatius St Helena St Kitts-Nevis St Lucia St Maarten St Pierre & Miquelon St Vincent & Grenadines Sudan Suriname Swaziland Sweden Switzerland Syria Tahiti Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Turks & Caicos Is Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Vietnam Virgin Islands (Brit) Virgin Islands (USA) Wake Island Wallis & Futana Is Yemen Zaire Zambia Zimbabwe
What is the best way to contact you? *	Home Phone Mobile Phone Work Phone E-mail Address
Passport Information
Citizenship *
Place of Passport Issue *
Passport Number *
Issue Date *	1 2 3 4 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 31   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908
Expiration Date *	1 2 3 4 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 31   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   2108 2107 2106 2105 2104 2103 2102 2101 2100 2099 2098 2097 2096 2095 2094 2093 2092 2091 2090 2089 2088 2087 2086 2085 2084 2083 2082 2081 2080 2079 2078 2077 2076 2075 2074 2073 2072 2071 2070 2069 2068 2067 2066 2065 2064 2063 2062 2061 2060 2059 2058 2057 2056 2055 2054 2053 2052 2051 2050 2049 2048 2047 2046 2045 2044 2043 2042 2041 2040 2039 2038 2037 2036 2035 2034 2033 2032 2031 2030 2029 2028 2027 2026 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908
Date of Birth *	1 2 3 4 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 31   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908
Gender *	Male Female
What is your ethnicity?
How did you first hear about the trip?	Internet Search (i.e. Google) E-mail alert/newsletter Event (conference, etc.) Friend's Recomendation Mailing (flier, postcard, etc.) Other
Would you like to receive our periodic mailings? *	Yes No
Would you like to receive our e-mail newsletter? *	Yes No
Session *	A) June 19th-August 14th (2 months) B) June 19th-July 17th (One Month) C) July 17th-August 14th (One Month)
Emergency Contact Information * (Please provide information on who should be contacted in case of emergency, please include their name, their phone number and any other relevant info.)
Do you have any allergies? *	Yes No
If so, please list: none
Are you a vegetarian? *	Yes No
Special Needs (please list any special dietary needs or other concerns or medical needs that might impact your trip)
Have you traveled to the Middle East before?	Yes No
If so, where and why?
Is there someone else participating in the program who you would like to be housed with? If so, write their name here:
Are you married? *	Yes No
Is your spouse or partner also participating in this trip? *	Yes No
Do you have any children attending? *	Yes No
General Information > Volunteer Assesment > Arabic Proficiency > Liability Form > Confirmation

Damascus Summer Encounter Registration form
Section II: Volunteer Assesment
General Information > Volunteer Assesment > Arabic Proficiency > Liability Form > Confirmation * denotes a required field Note: Please take your time with this section! Some of the questions require careful consideration and may (if noted) require you to enter a minimum number of words or characters.
What do you hope to gain from participating in the Summer Program? Be detailed (30 words minimum). List your goals and expectations. *
Personal References: Please list below the names, profesions and the daytime phone numbers of at least two references (former employers, University profesors, coworkers, etc.)
Personal Reference #1 *
Personal Reference #2
Do you have a criminal record? *	Yes No
If yes, please explain
Relevant Experience: Please list below all previous places of employment or previous volunteer positions or extra curricular activities (student newspaper, research project, etc.) Please list company name, your role in the organization and the dates which you were employed. If you have no former places of employment or volunteer positions, please type "none" into the box below.
Please be detailed and specific: *
Strengths and Weaknesses Please list below some of your skills and strengths and some of your weak areas. (Example: "My strengths are my writing skills, my ability to listen well to others. My organizational skills, however, are pretty weak").
Please be detailed and specific: *
Education: Please list below the highest level of degree earned (high school, college, etc.) and names of academic institutions you attended or are currently attending.
Degrees earned/in progress: *
Volunteer Opportunity Interests Below is a list of some of the most common types of volunteer opportunities. Please rank your level of interest in each type of volunteer opportunity from 1 to 5 (5 being the highest)
Working with kids (summer camps/sports camps) *	1 (no interest) 2 (low interest) 3 (somewhat interested) 4 (interested) 5 (very interested)
Tutoring/Teaching English (Teens/College age students) *	1 (no interest) 2 (low interest) 3 (somewhat interested) 4 (interested) 5 (very interested)
Web Design *	1 (no interest) 2 (low interest) 3 (somewhat interested) 4 (interested) 5 (very interested)
Administrative (research, grant writing, office work, editing documents) *	1 (no interest) 2 (low interest) 3 (somewhat interested) 4 (interested) 5 (very interested)
General Information > Volunteer Assesment > Arabic Proficiency > Liability Form > Confirmation

Damascus Summer Encounter Registration form
Section III: Arabic Proficiency Questionaire
General Information > Volunteer Assesment > Arabic Proficiency > Liability Form > Confirmation * denotes a required field
Please describe your current familiarity with the Arabic language *	I have no background in Arabic I speak a little bit of Arabic/know a few words I speak and read Arabic at a beginner's level I speak and read Arabic at an intermediate/advanced level I am fluent in Arabic
Have you ever studied Arabic for a semester or more at school? *	Yes No
How many hours or how many semesters have you studied Arabic?
What type(s) of Arabic have you studied (i.e. Egyptian colloquial, Syrian colloquial, modern standard, classical arabic, etc.)
Did you use transliteration or Arabic script in your studies?
Do you currently practice Arabic on a regular basis?	Yes No
General Information > Volunteer Assesment > Arabic Proficiency > Liability Form > Confirmation

Damascus Summer Encounter Registration form

Section IV: Liability Form

General Information > Volunteer Assesment > Arabic Proficiency > Liability Form > Confirmation * denotes a required field

I confirm that: 1. All information I have provided in the registration process is correct to the best of my knowledge. 2. I appreciate the risks inherent to travel within the Middle East, including the risk of discomfort, delay, inconvenience, changes to itinerary as well as physical and mental injury, disablement or death. I accept that Middle East Fellowship reserves the right to change the itinerary without notice, if circumstances require. 3. I am responsible for my own travel insurance arrangements and I accept that Middle East Fellowship will not be liable for loss of or damage to property, or for injury or death however arising. 4. I will maintain timetable and group decisions, particularly rendezvous times and places. 5. I will remain non-violent, both in speech and in actions, throughout my journey and visit 6. I accept that Middle East Fellowship and its agents reserve the right to remove individuals from the program whose behavior, in the sole opinion of our staff, puts themselves or anyone in danger. 7. I accept that I will be removed from the program if I participate in any activity that Middle East Fellowship and its agents deems culturally inappropriate for the Middle East. 8. I understand and accept that Middle East Fellowship reserves the right to use photos taken during the trip with my image and likeness in any official promotional material. 9. I understand that payment for the trip is only partially refundable. Cancellation will result in the loss of the registration fee and flight cost. In addition, if cancellation occurs less than 60 days before official start date of trip, participant will be liable for a $100 cancellation fee. If Middle East Fellowship is forced to cancel a trip for any reason, all payments will be refunded to participant with the exception of the registration and any flight costs. 10. I understand that full payment is due two weeks prior to departure and that failure to pay on time will result in cancellation of participation and loss of registration fee.

If you agree to all of the terms and conditions listed above, please type "I agree" in this field. Your application will not be considered complete until you have agreed to the terms and conditions above. *

General Information > Volunteer Assesment > Arabic Proficiency > Liability Form > Confirmation