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Refugee Response Team Registration Form
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Section I: General Information
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First Name *
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Middle Name
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Last Name *
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[Note: Please type your full name, above, exactly as it appears on your passport]
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Home Phone Number *
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Mobile Phone Number
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Work Phone Number
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E-mail Address *
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Mailing Address:
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Street Address *
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City *
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State (U.S. Only)
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Zip Code *
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Country *
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What is the best way to contact you? *
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Passport Information
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Citizenship *
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Place of Passport Issue *
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Passport Number *
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Issue Date *
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Expiration Date *
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Date of Birth *
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Gender *
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What is your ethnicity?
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How did you first hear about the trip?
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Would you like to receive our periodic mailings? *
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Would you like to receive our e-mail newsletter? *
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Emergency Contact Information *
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Do you have any allergies? *
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If so, please list:
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Are you a vegetarian? *
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Special Needs
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Have you traveled to the Middle East before?
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If so, where and why?
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Is there someone else participating in the program who you would like to be housed with? If so, write their name here:
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Are you married? *
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Is your spouse or partner also participating in this trip? *
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Do you have any children attending? *
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Brief Bio (In 30-50 words please tell us a bit about yourself. Employment, education, volunteer work, interests, purpose for joining the program, etc.) *
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In brief, please explain why you want to join the Refugee Response Team and what sparked your interest in the plight of refugees. *
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Refugee Response Team Registration Form
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Section II: Liability Form
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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 accept that neither Middle East Fellowship nor its affiliates will 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 (if applicable). 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.
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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. *
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