Welcome to our unique Expedition/Course/Project/Program designed to give You some revelant experience in conservation biology working with flora and fauna species. Please print all information and mail with your non-refundable deposit payable to EARTHQUEST.

Personal Stats:

Home Phone: ___________________
School/Work Phone: ____________________
Email Address: __________________________

From where did you hear about us:

Plantedu.com	LeapNow	Center for Interim Programs	Volunteers for Peace
Yes_____ No_____	Yes_____ No_____	Yes_____ No_____	Yes_____ No_____
KIVA FOR UNESCO	Internet Search Engine	Transitions Abroad	GoAbroad.com
Yes_____ No _____	Yes_____ No_____	Yes_____ No_____	Yes_____ No_____
Summer-student.com	University of Western Ontario	WorkingAbroad.com	University of Toronto
Yes_____ No _____	Yes_____ No_____	Yes_____ No_____	Yes_____ No_____
LakeHead University	Word of mouth	EARTHQUEST Alumini	Other
Yes_____ No _____	Yes_____ No_____	Yes_____ No_____	Yes_____ No_____

I am applying for;

Expedition	FAT training	Biological Field School	Internship	Courses	Membership
Yes_____ No _____	Yes_____ No_____	Yes_____ No_____
Yes_____ No_____
Yes_____ No_____
Yes_____ No_____

Expedition Selection:

Nicaragua/Costa Rica Ethnobotany Program

Nicaragua Primate Program

Nicaragua Primate Program

Nicaragua Primate Program

Costa Rica Primate Program

Canada Primate Program

Costa Rica Rainforest Conservation Program

Bruce Trail Project

Biological Field School near Aylmer, Ontario, Canada

FAT Program	Internships	Waiting list
Summer, 2009	Starting June 1, 2009
Yes_____ No _____	Yes_____ No_____	Yes_____ No_____

General Field Assistant Self Study Training Courses

FASST Course	AFASST Course	Waiting list
May 15, 2009	Starting May 15, 2009
Yes_____ No _____	Yes_____ No_____	Yes_____ No_____

Medicinal Plant Field Assistant Self Study Training Courses

FASST Course	AFASST Course	Waiting list
May 15, 2009	Starting May 15, 2009
Yes_____ No _____	Yes_____ No_____	Yes_____ No_____

Primate Field Assistant Self Study Training Courses

FASST Course	AFASST Course	Waiting list
May 15, 2009	Starting May 15, 2009
Yes_____ No _____	Yes_____ No_____	Yes_____ No_____

Please note that we reserve the right to choose where you do your AFASST Course training. Moreover, we have the right to choose, refuse or accept your participation. Where would you like to do your AFASST Course?

London, Ontario, Canada Yes _____ No _____

Host country Yes _____ No _____

If your program/project/course is altered, changed or cancelled what is your program
Second choice: ________________________________________________
Third choice: __________________________________________________

Are there any dietary/medical requirements we should know about?
____________________________________________

I (please sign your name) ____________________________________
have read all the terms and conditions explained on the EARTHQUEST webpage located at the following link; http://www.oocities.org/earthquestcanada/Termsandconditions.html regarding the refund policy, program/project/course or Expedition change, cancellation, altering as a result of events out of control of EARTHQUEST (Canada) and my participation in the program/project/course or Expedition and agree to them.

Deposit Requirements

*Note*: Applicants who do not submit a non-refundable deposit of $580.00 Cdn for the Biological Field School, internships and projects/programs/courses or projects and a $100.00 US/person non-refundable deposit for Regular Expeditions, $575.00 US/person non-refundable deposit for the Medicinal plant Level 1 FASST Course, $599.00 US/person + $80.00 Cdn non-refundable deposit for Nicaragua/Costa Rica/Canada Primate Program, or a $575.00 US/person non-refundable deposit for Nicaragua/Costa Rica Ethnobotany or Costa Rica Rainforest Ecology and Conservation program on the due date will not be considered for the program. There is a $50.00 US/person late fee if you miss the deposit deadline (ie. all deposits must be RECEIVED by the deposit deadline date - postmarked by mail does not count).

Enclosed is my non-refundable $100.00 US/person deposit to secure a spot on a Regular Expedition team
Yes_____ No_____

Enclosed is my non-refundable $580.00 Cdn/person deposit to secure a spot in the Canadian Biological Field School
Yes_____ No_____

Enclosed is my non-refundable $575.00 US/person deposit to secure a spot on a Level 1 Medicinal plant FASST course
Yes_____ No_____

Enclosed is my non-refundable $25.00 US/person membership fee for 1 year
Yes_____ No_____

Enclosed is my non-refundable $575.00 US/person deposit to secure a spot on a Nicaraguan/Costa Rican project/course/program
Yes_____ No_____

Enclosed is my non-refundable $599.00 US/person + $80.00 Cdn deposit to secure a spot on a Nicaraguan/Costa Rican Primate Program
Yes_____ No_____

General Questions

1. List revelant academic, work, volunteer or training experience with animals. Please note particularly any experience with endangered species.
________________________________________________________________________________________
________________________________________________________________________________________

2. List participation in sports, outdoor recreation activities, natural history pursuits, and revelant hobbies. List awards or training certificates in any of these activities you have received.
_______________________________________________________________________________________________
_______________________________________________________________________________________________

3. Do you have any spoken or written fluency in Spanish
Yes_____ No_____
If yes, list Spanish studies or experience.
_______________________________________________________________________________________________

4. Have you traveled outside North America
Yes_____ No_____
If yes, please list where and briefly describe your experience.
_______________________________________________________________________________________________
_______________________________________________________________________________________________

APPLICATION DEADLINE:

30 days after acceptance

NON-REFUNDABLE DEPOSIT DEADLINE:

14 days after acceptance (ie. once accepted you have 14 days to submit your non-refundable deposit - postmarked by mail DOES NOT count)

You may FAX your application into the following phone number; (519) 773-5489. Please direct it to the attention of;
Mr. D. Jolly, B.Sc.,
Executive Director

, or you may email.

Non-refundable deposits are payable by certified cheque, money order or direct deposit into the EARTHQUEST General Canada Trust/TD bank account (Please ask for account # if you choose this method of payment). Personal cheques are not accepted and will be returned, delaying your acceptance (ie. you may be charged a late fee as a result). The other option is to wire funds directly to EARTHQUEST. There is a $10.00 US service charge if you choose to wire funds to EARTHQUEST, however (ie. please add this amount to your payment). For the banking information on wiring funds please click here..

The quickest method, however is to send funds via Western Union (as this may be accomplished within 15 minutes of the transaction), but you must notify the office if you intend to use this method.

Executive Director & Senior Instructor
D. Jolly, B.Sc.

EARTHQUEST (Canada) for the Environment 8122 Rogers Rd. S., RR #5 Aylmer, Ontario, Canada N5H 2R4 Tel: 519-875-3340 e-mail: earthquest@hotmail.com �copyright EARTHQUEST (Canada) for the Environment	Website designed and maintained by D. Jolly Last Updated 04/04/09