Registration.

SORRY for the inconvenience, but our Registration page is having some problems. While we are working to repair it you can bypass most of this page and just scroll down to the bottom and click on the "Submit Registration" button to send us an email. Be sure to include your contact information in the email and we will contact you and personally help you register another way
Disregard the paragraph below... for now.

Please complete this registration form. We need to know as much about you as you are willing to share - don't worry, we won't ask you anything embarrassing or dangerous. Please be as complete as you can be. The more we know about you the closer we can tailor the trip to your particular needs and skills.

Your name as it appears on your passport:

Title:
(Mr.)
First Name:
(John)
Middle Name:
(David)
Last Name:
(Doe)
Suffix:
(Jr.)
Degree:
(Ph.D.)
Preferred Name:
(John David)
Your Address:

Address:
(123 State St)
City:
(Portland)
State:
(OR)
Zip:
(97226)
Country:
(US)
Passport Information (Optional):

Passport Number:
( L898902C)
Issuing Country:
(US)
Expiration Date:
(01 15 2009)

Demographics:

Gender:
(choose option)
Birdthday:
(01 15 1970)
Contact Information:

Work/Office Phone #1:
(503-123-4567)
Work/Office Phone #2:
(503-123-4568)
Home Phone:
(503-123-4569)
Mobile Phone:
(503-123-4561)
Fax:
(503-123-4562)
Email #1:
(jdavid@gmail.com)
Email #2:
(johnd@hotmail.com)
Other Information:

Professional, Training or Special Skills:


Specific Projects you are interested in:


How did you hear about us?


Additional Information:

Languages Spoken: (english, spanish, german, etc.)

Religious Preferences:

Dietary Restrictions:

Health Restrictions:


Comments & Other information you believe we need to know: