Tambora Archaeological Project-application Form

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Tambora Archaeological Project Applicant Information Sheet A bank deposit of us$ 300 (or 200GBP or 200Euro) is required**, before Feb.15 2010, in order to purchase the domestic airline-tickets of which you will receive a receipt/confirmation. To: Danamon Bank Ubud Branch-842 Jalan Ida Bagus Manik Peliatan - Ubud - Bali Indonesia SWIFT CODE: BDINIDJA Beneficiary: R.J Stoetman account number: 11839321 Please email details of the bank transfer to mailto:[email protected] **Balance on arrival, in Cash

Personal Details Full Name: Date of Birth: Nationality: Passport No.: Passport Expires: Insurance Carrier: Policy No.: Telephone: E-mail Address: Website/blog address (if any):

Current Address Address: City: ZIP Code: State: Country:

Permanent Address Address: City: ZIP Code:

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State: Country:

Duration Stay Date of arrival in Bali: Date of departure: Archaeological Experience: Your Health Condition: � Excellent �Good �Fair �Poor Describe any physical conditions that may limit your activities

Contact in case of emergency Full Name: Address: City: ZIP Code: State: Country: Telephone: Cellular Phone: I will bring my own �tent �sleeping-mat&bag I need simple accommodation

Date:

Your signature:

PleaSe…

Email your application-form to: [email protected]

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…tell us more about yourself; we appreciate getting acquainted with you and feel free to be explicit.

“I want to join the archaeological excavations, on Mount Tambora in Sumbawa , because…”