St. Thomas More Newman Center Delegate Application 2020

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Please note the following instructions for completing the delegate application:

Fill out the following form completely. Once finished, the form will be submitted to the SHARE Delegation Coordinator and the US Organizer.

Also be sure to print, sign, and date Liability Waiver (all delegates) and Parent Permission Form (delegates under 18 years of age only) found on the SHARE Delegate Application page. Give these forms, along with a copy of the photo page of your valid passport, to your US Organizer.

Delegate Information

Complete using legal name on your passport

First Name *

Last Name *

Gender *

Female

Male

Date of Birth *

YYYY

Place of Birth *

Citizenship *

Profession or Area of Study *

Passport Number *

Passport Expiration Date *

YYYY

Address *

Street Address, City, State, Zip Code

Primary Phone Number *

School Email Address *

Personal Email Address *

Emergency Contact Information (if under 18, this should be your parent/guardian)

Emergency Contact Name *

Relationship to applicant *

Emergency Contact Number *

Additional Phone Numbers

Emergency Contact E-mail *

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