New Page 1

To Request for More Information

[This mission is not a project or program of Rose-Hulman Institute of Technology. The ideas and opinions are those of the author and not the Institute. The mission is an independent program sponsored by the Terre Haute District United Methodist Churches and the Russian Initiative of the General Board of Global Managers of the United Methodist Churches of America. The program has been organised by Peter Priest, a retired Rose-Hulman professor of Russian, who is merely continuing his life's work of helping people learn about and build relationships with the Russians.]

or To Apply for a Mission Project Team

Dear Travel Coach and/orTeam Leader;

Part 1--To request more information: If you are requesting information, you need only fill in the first part of this questionnaire, that is, give your name, address, phone, E-mail.

I want more information; please call.
I want more information; please E-mail me.
Tell me more about

Send me information about future UMVIM projects in Russia.

Gender *Last Name as shown on Passport :

*First Name as shown on Passport:

Preferred or Nick Name:

*Middle Name(s) as shown on Passport:

E-mail:

Day phone: Evening phone:

Street address:

City: State:& zip

Stop here if you are only requesting information.

Continue below if you are applying for a mission project team.

Part 2--To apply for an UMVIM Mission Project Team: If you are applying for one (or more) of the UMVIM projects, you must complete all items below on this form. Items marked by an asterisk (*) are required by the Russian visa application. Other items help us know you.

Sounds great! I want to sign up for:
Team One May 14 to May 27
Team Two June 14 to June 27

Be sure to enter your name and address information in Part I above.

*Date of Birth (m/d/yr): month (mm) day (dd) year (yy)

*Occupation: *Citizenship:

*U.S. Passport No.
*Date of Expiration month: year:
*City Passport Issued at:

If you do not have a passport at this time, call your local post office and ask where the nearest passport clerk is (usually at the central post office facility). Then pay for expedited processing. We must have your passport information before we can 1) apply for an official invitation which is a prerequisite for applying for a Russian visa. Unlike traveling to destinations in Europe, which you as an American can visit without a visa, you must have a valid Russian visa before you can board your flight to Russia.

*Maiden and/or other last names used
*Country of Birth: *

Place [city and state] of Birth as shown on Passport:

E-mail: priest@rose-hulman.edu

Home