Have you been involved in any similar projects previously, if so please give details.
GENDER
DATE OF BIRTH
Describe your state of physical fitness (include physical limitations, handicaps, allergies, etc).
M
F
List medications you are presently taking and for what condition.
NATIONALITY
Country of issue of Passport
PASSPORT NUMBER
PASSPORT EXPIRY DATE
Note: Passport MUST be valid for 6 months beyond departure date.
DEPOSIT: As a confirmation of your commitment to the Project, a non-refundable deposit of €500 must be returned with your completed application form. This deposit will be treated as your first instalment of the €1,500 sponsorship required to participate in the Project. Cheques/bank drafts should be made payable to The Irish Lebanon Project.
Note: completed application forms
received without deposits and Passport
photocopy will not be processed.
List any special skills or experience you feel you can
contribute to the School Project
Note: Team members over 55 years of age will be required to submit written permission form their doctor(s).
Do you have special dietary requirements?
YES
NO
If yes, please give details:
Accommodation in Lebanon will be on a shared, room basis. If there are any other applicants with whom you have a preference to share, please give details:
Please return completed form together with your sponsorship deposit of €500 to: Micheál Mac Diarmada. The Irish Lebanon Project, Coolbawn Lodge, Caheragh, Drimoleague, Co. Cork. If there is not enough space on this form to give details of questions above please use the space on the reverse of this page.
APPLICATION FOR THE IRISH LEBANON PROJECT 2011
TERMS AND CONDITIONS FOR 2011 . You are required to pay a deposit of €500.00 for the Project which must been enclosed with your application form to secure your place. You must undertake to raise a minimum of €1,500.00 for your participation with the Project for 10 days. A deposit of €500.00 must accompany your application form. The balance of €1,000.00 must be received by the end of the month prior to travelling as the accommodation and Airline bookings will require full payment at this time. You must be at least 18 years old before the Project departure date. Your passport must have 6 months to run from the date of entry into the destination.
Participants must be relatively fit to travel during the Project and you must complete the medical questions on the Application Form. If you are over 55 years old, or if you have any sort of medical condition that could be adversely affected by exercise, particularly any sort of heart condition, you must obtain a medical certificate from your doctor. By signing the application form you are confirming that, to the best of your knowledge, your general state of health is good and that you take full responsibility for yourself. Participants must also let The Irish Lebanon Project know of any change in medical condition that occurs between submitting the medical form and the departure date, including pregnancy. The Irish Lebanon Project has the right to refuse a participant if they are deemed medically unfit to take part.
Passport control and In-Country authorities will reserve the right to refuse entry. If The Irish Lebanon Project considers you at any stage unsuitable for the project, it may at its absolute discretion cancel any offer made to you to take part in the Project that has been made to you, or decline to involve you further in the Project once the Project has commenced, particularly if your participation causes inconvenience or annoyance to other persons involved in the Project.
If you commit an illegal or unlawful act you may be excluded from the Project and The Irish Lebanon Project shall not be responsible to you, or for you, thereafter. You must not use The Irish Lebanon Project name, or your association with it, for any purpose other than to fundraise in respect of your involvement in the Project. The Irish Lebanon Project reserves at its absolute discretion the right to refuse your application, in which case your registration fee of €500.00 will be returned to you.