"Improving the Day to Day of Athletic Healthcare"
We look forward to having you on our upcoming Student International Experience to Italy.
We need the following information completed fully to complete your registration process.
Name (as it appears on your passport):
Name (as you would prefer to be called):
Traveler Cell Phone:
Week of Travel:
Date of Birth (MM/DD/YYYY)
Country of Origin (on passport):
Passport Expiration Date:
Roommate Request (Name):
Any Medical Issues we need to know of:
Food Allergies / Special Diet:
Emergency Contact Information:
Cell Phone #: