2016World Affairs Seminar ApplicationJune 25 – July 1, 2016
Global Energy: Who’s Got The Power
PLEASE PRINT: Thank you for completing all information accurately and legibly.
Name ______
First (as you want it to appear on name badge)MILast
Male FemaleBirth Date: ____ /_____ /______Year in school (as of May 2016): ______
(Circle one) Mo Day Year
Email address: ______Phone number: ( )______
Mother or GuardianFather or Guardian
Name: ______Name: ______
Email: ______Email: ______
Work phone number: ( )______Work phone number: ( )______
Home phone number: ( )______Home phone number: ( )______
Cell phone number: ( )______Cell phone number: ( )______
Mailing address: ______
City, State/Province, Zip/Postal code: ______
Delegate preferred method of contact: Mail Email
Parent preferred method of contact: Mail Email
High School name: ______
High School address: ______
City, State/Province, Zip/Postal code:______
GPA/Average Cumulative Grade: ______
I will arrive at the World Affairs Seminar by:
Using the transportation service and am enclosing the Transportation Request Form
Being dropped off by parents/guardians or other relatives Driving my own vehicle
DelegateFirst Name: ______Last Name: ______
By signing this application, the school official is endorsing the applicant as a person with creditable academic standing, a high standard of integrity and maturity, and a sincere desire to participate in the unique educational format of the World Affairs Seminar.
Name of School Official: ______Position/Title: ______
FirstLast
Signature of School Official: ______
Email address:______Phone: ( ) ______Ext: ___
This delegate has been selected to receive a scholarship to attend the 2015 World Affairs Seminar.
Name of sponsoring service club or organization: ______
District: ______Contact Person: ______
Contact’s email: ______Phone: ( ) ______
Mailing address: ______
City, State/Province, Zip/Postal code: ______
Preferred method of contact: Email Mail Phone
I agree to attend the entire event and to relate my experience at the Seminar my sponsor(s) at a meeting of your club or organization, or in essay form upon my return. If I cannot fulfill this agreement, I agree to reimburse my sponsor.
______
Signature of DelegateDateSignature of Parent/Guardian/Host Parent Date
$680 Domestic delegates (U.S. and Canada)
$580 International delegates (includes delegates in U.S. and Canada high schools on exchange programs)
Fees are payable in U.S. Dollars (USD) only.
Make checks payable to World Affairs Seminar.
MasterCard and Visa Credit cards are accepted over the phone. (We do not accept any other credit cards).
A check or money order is enclosed: $______No.______Date:______
Sponsor will send payment: Payor: ______
EFT (Electronic Funds Transfer): Contact WAS for instructions. EFT's may include processing fees if incurred.
Will pay by credit card over the phone.
Send completed applications and payments to:For questions:
World Affairs SeminarPhone: (414) 453-4984 FAX: (414) 431-0588
10600 W. Mitchell St.Email:
West Allis, WI53214Web:
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