Date of Birth *

MM

DD

YYYY

Phone *

(###)

###

####

Sex *

Female

Male

Gender *

As stated on passport or passport application

M

F

X

Are you a member of the Student Group Campus Collective? *

This lottery is open to all Ripon College Students whether you are or are not a member of Campus Collective.

Yes

No

Do you have a current and valid passport? *

If expired or expiring within 6 months of March 2024 answer no.

Yes

No

I understand that on this trip I will represent my school, my country, and Wisconsin Christian Campus Ministries (hereafter WCCM). I agree to conduct myself at all times in a way that honors those entities. *

Yes

No

I understand that if selected (as a primary attendee or alternate) I must provide proof of a valid passport or proof of passport application submission by November 10th in order to maintain my position in the trip. *

Yes

No

Are you aware of any warrants or any other Local, State, Federal, or International restrictions that would prevent you from traveling outside the U.S. or entering any country in the European Union? *

Yes

No

I understand that there is inherent risk involved in an international trip of this nature and will assume all risk related to participating in this trip releasing Wisconsin Christian Campus Ministries from all liability. *

Yes

No