Be Part of the Next Generation of Cultural Ambassadors

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Gender *

Male

Female

Non-binary

Prefer not to say

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have you ever been to China before? *

Yes

No

Do you have any dietary restrictions or allergies? *

Yes

No

Do you have any medical conditions or special needs we should be aware of? *

Yes

No

Emergency contact phone *

(###)

###

####

I confirm that all information provided is accurate and complete *

Yes

I understand that if selected, I will be required to *

Attend all program activities. Abide by the program’s rules and guidelines.

Agree