Student-Faculty Fellows Participant Information and Waiver (Faculty Form) Everyone participating in the ASIANetwork Student-Faculty Fellows program must complete this form and waiver.Your Name(Required)College/University(Required)Project Title(Required)Project Country(Required)Expected Project Travel Year(Required)Your Faculty Partner (If Applicable)Gender(Required)Citizenship(Required)Native Language(Required)Asian Language #1Asian Language #2College Email(Required)Personal Email(Required)Cell Phone(Required)Permanent Address(Required)Emergency Contact #1Name(Required)Relationship to You(Required)Address(Required)Phone(Required)Emergency Contact #2NameRelationship to YouAddressPhoneWaiver FormASIANetwork Freeman Student-Faculty Fellows Program Participant Waiver THIS IS A RELEASE--READ IT CAREFULLY The undersigned, in applying for participation in the ASIANetwork Freeman Student-Faculty Fellows Program, hereby forever releases ASIANetwork and any officer, employee, director or agent thereof of and from any and all liability for any act or omission of any kind of character whatsoever and releases them from any costs, damages, and claims or assertions of any kind with respect to which I or my heirs, successors, or assigns may claim against them and specifically without limitation agree as follows: I release the Program Director, ASIANetwork, and any employee, servant, agent, officer or director thereof, from any liability for injury to myself or any damage to or loss of my possessions caused by acts of omission of any hotels, carriers, fellow participants, restaurants, educational organizations, persons, groups, or organizations, including but not limited to ASIANetwork, their officers, employees, directors, agents or servants in connection with the work or study thereunder. I have read the foregoing release and agreement and I accept the conditions stated therein.Electronic Signature(Required)(enter your legal name)Date(Required)
