Bowling Green State University
Hanoi University of Education
2007 Joint Field Study of Viet Nam
Application Form
   
   
Name:____________________________________________  SSN#  ______________________________
             (last name)                    (first name)                (MI) Tel. (H)  _____________________________
Address:_________________________________________  Fax (if any):  _________________________
________________________________________________  E-Mail (if any):  _______________________
________________________________________________  Country of Residence: _________________
Country of Citizenship:  ____________________________ Place of Birth: _______________________
Passport No.  ____________________________________ Date of Birth: ________________________
Place of Issue:____________________________________
Date of Issue:____________________________________   
Date of Expiry: __________________________________  
Occupation:________________________________
Place of employment:_________________________
Telephone (Work):___________________________

Registration Deadline: May 31, 2007
Deadline for payment of non-tuition fees: June 15, 2007

If for credit, # of credit hours (1-3 ):  ____ Major:________ Academic Program:__________________________
Year  (freshman, sophomore, junior, senior, etc…): ______________________________________________
College/ University (if other than BGSU): _______________________________________________________

Mode of Payment: (check one): DEBIT CARD  DISCOVER  MASTERCARD  CHECK

Account Number:________________________  Expiration Date: ___________________________________
Signature: _______________________________________________________________________________
Rooming Preference (single/double occupancy):________________________________________________
Meal Preference (Vegetarian, Regular, Diabetic, Low-Sodium, etc…): _______________________________
 
To reserve a seat in the course, please complete application form and mail, along with a check for US$50, payable to Bowling Green State University, to:
 
Dr. Benjamin N. Muego
Professor of Political Science & AsianStudies
104 Hanna Hall
Bowling Green State University
Bowling Green, Ohio 43403-0225 		or Dr. Benjamin N. Muego
Professor of Political Science
Room 320-D, West Building
BGSU Firelands
Huron, Ohio 44839-9791