ARTIS: Registration Form

1709 Apache Drive - Medford, OR 97501

Registration form for Participation
in Summer Study Programs
Deposits must accompany your registration forms.

5.	Marital Status:		6.	Sex:
7.	Date of Birth:		8.	Citizenship and City of Birth:

9.	In Case of Emergency, Notify:	First and Last Name and relationship to you.
	Mailing Address:	Street Address
	City State Zip:
	Home & Work Phone:

10.

Which ARTIS Program do you want to sign up for?

Italy

Bali

Myanmar

Place an "X" in appropriate box

10a.	Which section and dates do you want to sign up for?

10b.

If in Florence's June-July session:Do you want to sign-up for the optional Venice side-trip for an additional $330?

YES

11.	Are you willing to share a double room?	YES	NO
12.	or do you prefer a single room at supplemental cost?	YES	NO
12a.	Do you want to stay in clean student quality apts.?	YES	NO
12b.	or do you want to upgrade to better accommodations at supplemental cost?	YES	NO

13.	If you are a married couple are you willing to share an apartment with other married couples (private bedroom, common bath and kitchen)?	YES	NO
13a.	or do you need a private apartment at supplemental cost?	YES	NO
14.	During excursions are you willing to share a room with 3-5 people?	YES	NO
14a.	or do you need a private hotel room at additional cost?	YES	NO
15.	Do you smoke?	YES	NO
15a.	Do you have dietary restrictions?	YES	NO

16.	How did you find out about the ARTIS Program?

16a.	If referred, whom may we thank? Give name

17.	Are you going to travel independently after the program?

17a.	If so, what is your exact return date to USA? (It should be on a Monday through Thursday)

18.	Which city of origin will you fly from to go to the international departure city (airport)?

19.	If on the airplane you need special meals, please list

	Comments or things we should know.

FOR STUDENTS ONLY:

20.	Do you need College registration info?	YES	NO
21.	Do you want college credit?	YES	NO
22.	Do you intend to apply for financial aid?	YES	NO