Gender |
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Role
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Title
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(Mr. Mrs. Ms.)
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First Name
(Given
Name)
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(As it appears on your passport.) |
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Last Name
(Family Name)
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(As it appears on your passport.)
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Badge Name |
(Name you like to be printed on your badge, 20 Characters maximum.) |
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E-mail
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Confirm your E-mail
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Street Address
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City
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State or Province
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Postal Code
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Country of Residence
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(Part of your postal address - where you are living now.)
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Home Telephone #
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Alternative
Phone #
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Mobile Telephone #
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Fax #
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Country Issuing Passport
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Passport Number
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Passport
Expiration Date
|
month
day
year
Make sure your Passort is NOT expired. |
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Birthdate
|
month
day
year
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Language |
If you can speak English fluently, select English.
Otherwise
select
your preferred primary language. |
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Other
Languages
|
Enter other languages you are fluent in.
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Food Requirement
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Clothing
Size
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Weight (in kg)
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or enter
pounds:
if you do not know your weight kilograms.
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Height (in cm)
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or enter inches:
if you do not know your height in centimeters.
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Faith / Religion
|
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Emergency Contact and Medical Information |
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If you have been invited by Recuiter,
Please enter the his or her name here:
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Optional Programs |
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Check here if you are interested in observing would like to observe the International Marriage Blessing ceremony. |
|
Check
here if you are interested in observing the Mister and Miss University International Beauty Pagent. |
|
Check
here if you are interested in joining the international volunteer
service project. |