Baltics 2013 Registration        
                          

 

 

 

Primary Traveler Additional Traveler Submit Confirmation


We hope you can join the AYA and fellow Yale Alumni in this extraordinary opportunity - an opportunity to be an ambassador for Yale and the U.S. and to help develop alumni leadership at world leading universities in Vilnius and Riga from July 9 - 17, 2013 (note that means leaving the U.S. on July 8). You can download the itinerary here.

Please complete your application as early as possible - applications are being considered based on your volunteer leadership at Yale. If the program is filled or you are not selected for the program, your full deposit will be returned. The deadline for applications to the program is March 15, 2013 (on-line submittal of information and credit card payment of the deposit of $1,000 per person towards the $3,500 total cost of the program per person.) Final payment will be due on May 1, 2013.

If you have any questions, please contact the AYA (either (i) Kathy Edersheim at (203) 432-1938 or kathy.edersheim@yale.edu; or (ii) Marv Berenblum at mberenblum@nesc.org.) For information about YaleGALE, visit our website at www.yalegale.org.

Please read the Terms and Conditions before completing the registration.

Required fields are marked with an "*"

PRIMARY TRAVELER - STEP 1

 

 
YaleGALE in the Baltics Deposit $1,000.00 # of people
______________________________________________________________________________________

Primary Traveler Contact Information

First Name: * 
Last Name: * 
Informal First Name (for name badge): * 
Please upload your photo for the Participant Directory if currently available: (jpg)  upload
Address: * 
Address 2: 
City: * 
State/Province: * 
Postal Code: * 
Preferred Phone: * 
Alternate Phone: 
E-mail: * 
Date of Birth: (DD/MM/YYYY) * 
Yale Affiliation, if any: * 
Yale Degree(s), if any:
School at Yale: 
Yale degree: 
Degree Year: 
______________________________________________________________________________________

Business Information

Occupation (If retired, from what position & company?): 
Title: 
Company Name: 
Business Address: 
Business Address 2: 
Business City: 
Business State/Province: 
Business Postal Code: 
Business Phone: 
Business Fax: 
Business E-mail: 
______________________________________________________________________________________