Educators Field Study Payment Portal: Check or Money Order

Personal Information

Email Address*

Participants Name (as it appears on passport) First, Middle, Last*

Sex* Male Female

Date Of Birth*

Home Address (Street, City, State, Zip Code)*

Use Google Smart Search for Address

Address 1:

City:

Country:

State/Province:

Postal Code:

Mobile Phone Number (xxx)xxx-xxxx* - -

Allergies*

Physical Restrictions ie. Wheelchair Access, Assistive Devices

Name of Employer*

Occupation

How did you hear about ACES International?

Travel Information

Passport Number*

Passport Issue Date*

Passport Expiration Date*

Country of Issue*

Special Flight/Hotel Amenities (Added Expense) - Copy*

Name of Preferred Participant Roommate

Emergency Contact Information

Emergency Contact Information: First and Last Name*

Emergency Contact Information Relation to Participant*

Emergency Contact Information Primary Phone* - -

Emergency Contact Information Secondary Phone - -

Payment Due Dates

Cancelation/Refund Policies

• 30% penalty of remaining balance if cancelation notice is received between 60 days and second installment (November 15, 2024) prior to the travel departure date.
• 50% penalty of remaining balance if cancelation notice is given within 45-59 days prior to the travel departure date.
• 80% penalty of remaining balance if cancelation notice is given within 30-44 days prior to the travel departure date.
• No refund is available when the cancelation notice is received within 29 days of notice before the travel departure date.

Participant and Release Agreement

(Please Click The Link) - Copy* I Agree

Check/ Money Order : Area Cooperative Educational Services PO Box 10536 Albany, NY 12201-5536*