<p> APPLICATION IS DUE by July 15, 2013 to Liberty University, 1971 University Boulevard, School of Education, Japan Trip, Connie McDonald, Lynchburg, VA 24502. Liberty University ID Number: </p><p>Name Age: Gender: M / F: </p><p>E- mail Address: Mailing Address: Physical Address: City: </p><p>State/Province: Zip Code/Postal Code: Phone: With this application, I agree to the following if I am accepted for the trip: • A $300 registration fee will be paid by July 15, 2013. If your application is accepted, the registration fee will be applied to the Travel Fee of $2,500. If your application is not accepted, your $300 will be returned to you.</p><p>• Pay all deposits/ fees/ costs in fu ll a nd on t im e . o The registration fee of $300 is due on July 15, 2013 . o The remainder of the trip fee( $2,200) submitted by July 31, 2013. • Submit a copy of your current passport validation page with the application or by July 15, 2013. • I will abide by the Liberty Way. (Anyone not abiding by the Liberty Way will be dismissed from the group.) This trip abroad may demand moderate to significant foot travel as part of the experience. If this poses challenges to you as you consider this experience, please contact [email protected] to discuss your particular situation in this context and whether this trip is a good match. SIGNATURE: DATE: (By typing in your name you are electronically signing this document.) mm/dd/yyyy</p><p>For Office Use Only: Registration Fee Passport Validation Page Travel Ex Form</p>