Username or Email address: * Password: * Login Remember me Forgot password? Registration FormIf you have not registered, and wish to travel with Global Academics in the future, please complete the registration below. Choose Username * Your email address * Choose a password * Type password again * Address * Address 2 City * State * Zip * Primary Phone * Cell Phone * Are you an educator/teacher? * yes no If you answered yes, where do you teach/work? School: If you are not a teacher, what is your profession? Are you a college/university student? * yes no If you answered yes, where do you attend? If not are you willing to enroll as one for this trip? yes no Are you a U.S. Citizen? * yes no If No, what is your country of citizenship? Do you have a current U.S. or other passport? (valid passport required to travel outside the U.S.) yes no If you answer yes, be sure to fill out the next 3 questions U.S. Passport or other country? Passport Number What is your passport expiration date? (mm/dd/yyyy) I, (state your name) * Agree to: Secure a valid passport and ensure that it does not expire 6 months before of after your dates of travel. Complete all paperwork required Pay the full amount due by the deadlines of the payment plan Sign all waivers Understand that: I will receive updates and critical info by email $500 non-refundable deposit that counts towards the total due Signature (type your full name IN CAPS to signify your agreement) * Today's Date * You may also, print this form and mail it along with your deposit. Make your money orders/checks payable to Global Academics and mail all documents to: Global Academics Attn: Dr. Siri Brown 4100 Redwood Rd #376 Oakland, CA 94619 Contact: Dr. Siri Brown, Professor of African American Studies 510.649.5664 www.global-academics.org PLEASE ADD [email protected] TO YOUR ADDRESS BOOK, AND CHECK YOUR SPAM FOLDER FOR YOUR REGISTRATION CONFIRMATION LINK. Create new account
