Form Test Posted on June 11, 2018October 11, 2021 by tk_dai 1Personal Data 2Training 3Housing and Travel 4Financial Info First Name(Required) Last Name(Required) Email(Required) Phone(Required) Address(Required) Street Address City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Demographic Information We collect this information for internal use only. It will not be shared with any outside persons or groups. Racial Identity WhiteBlack or African AmericanAsianNative Hawaiian and Other Pacific IslanderSome Other RaceMultiracialPrefer not to Answer Gender MaleFemaleNon-binaryAgenderMy gender is not listedPrefer not to answer Age Under 1818-2425-3435-4445-5455-6465 or AbovePrefer Not to Answer Training Level(Required) 12 Instructor Referral Needed for advanced training consideration File For advanced training consideration, we ask for an instructor referral. As an alternative, a pdf of your resume or documentation of relevant stage combat experience may be included here: Accepted file types: pdf, Max. file size: 15 MB. Do you need housing?(Required) Yes No Special Accomodations Dueling Arts International is committed to equitable and ethical inclusion. Are you in need of special accommodations? No Yes Please list your needed accomodations here Travel Details(Required) You will be asked to provide your travel details one week prior to the first day of the workshop. Please respond with your commitment to provide specifics (flight arrival date and time, planned arrival by car, or local residence at workshop site). I will provide details Scholarship Dueling Arts International offers scholarships based on financial need. If you wish to apply for one of the scholarships, you will be redirected to the application process after you submit this form. Sincere and thoughtful inquiries will be considered. I would like to apply Deposit You will be taken to PayPal's checkout system when you click submit. Do NOT close the window or cancel the process unless you want to cancel your submission.The process is considered complete when PayPal notifies you of payment success and you are redirected back to our website.You do NOT need a PayPal account to make the payment. You may use a credit card through PayPal's interface. Secure your place in this course Price: Total
