RU YI Studio/Gallery Taos, New Mexico

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Application Form for All China Cultural Study Tours

PLEASE FILL OUT FORM FOR INFORMATION ON STUDY TOURS
Tour Name:
Dates:
Season:
First Name
Last Name
Phone (work)
Phone (home)
Email:
Street Address :
City:
State:
Zip:
US Passport:
Exp Date:
Date of Birth :
Citizenship:
Emergency Contact Person:
Emergency Email:
Street Address :
City:
State:
Zip:
Room Preference (single/double):	Single Double
Are you physically fit:	Yes No
Do you suffer from panic attacks/fear heights/ depression:	Yes No
If yes, are you being treated and with what?
List any past illness/surgery and include doctor's report if applicable::
List medications/dosage you require, if any :
List dietary requirements and allergies :
I understand I will encounter different living conditions, culture impact and geographical terrain while traveling in China. I understand I am required to purchase additional travel insurance to participate in the program. I will respect the culture difference and adapt to living conditions while traveling in China, I will cooperate with the rules and guidelines of the study course and participate in activities, or voluntarily leave the group at my own expense.
Please Initial for Electronic Signature

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