Booking a place as a Research Assistant or Dissertation/Thesis Volunteer
(Ohio, Michigan and Illinois ONLY. Please use one of the other forms if you are from another state.)

If you would like to download a copy of this form, click here.
 		  
 
Name Sex
(Full name as it appears on your passport)
University/College Date of Birth

Home Address (Please include city and province) University Term Address (include city and province)
Home Postal Code University Term Postal Code
Home Telephone Telephone number
Cellphone University Email
Home Email

Nationality Country of Expedition
(for possible visa implications)
Length of Expedition Start date of expedition in-country

Proposed Itinerary
Week number Option number or title
1
2
3
4
5
6
7
8
Although this is your proposed itinerary, please bear in mind that logistics in the field, in such
a remote part of the world, may require certain aspects of your itinerary to be changed at any time.

Reason you are joining the research program (Senior/Honors Thesis, Field Internship, Independent Research Study, Research Assistant, Other)

By ticking this box, you acknowledge that you have read and understood the booking conditions, and accept them.     Name
Date
By submitting this form, you are not confirmed on the expedition. Please call the office at (734) 418-2736 in order to pay your 10% deposit. Once we receive your deposit, your spot will be secured on the project of your choice