Music and Culture Travel Course in Bali, Indonesia

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Music and Culture Travel Course in Bali, Indonesia — June 3 to June 21, 2020

REGISTRATION FORM

Make your $500 bank payment to ‘Conrad Grebel University College' and complete this form. For further information, contact:

Professor Maisie Sum
Room 1102
Conrad Grebel University College
140 Westmount Road North
Waterloo, ON N2L 3G6

Email: msum@uwaterloo.ca

Name (last, first) *

Address *

Date of Birth *

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Gender Identity *

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female

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not listed (please write your gender identity in the space below)

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he/his

they/them

Email address *

Phone number *

Passport Number (if known)

Issuing Country of your Passport

Passport Expiry Date

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Roommate Preference (if any)

I am taking the course: *

for credit. I am a UWaterloo student.

for credit. I am not a UWaterloo student.

out of interest.

If you are taking the course for credit, in which term do you plan to enrol?

Winter 2020

Spring 2020

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Awards and financial aid are available to full-time students taking the course for credit. Submit a written request below, or email a written request to Professor Sum (msum@uwaterloo.ca).

Questions? Comments?

Indicate the date you completed the registration form. NOTE: The course requires a considerable amount of walking. Clicking submit indicates that you are aware of this and that, to the best of your knowledge, you are physically fit and can participate fully in the program. *

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