Registration Form

Note: You can pay for registration fees or deposits by check or cash at the ECIR office, 921 Church Street, Ann Arbor, MI 48104. Alternatively, you can mail a check payable to ECIR to that address. If you choose to use the online payment option, click on the “Donate” button.

Your Name (required)

Your Email (required)

Address (required)

Phone (required)

Program Registering For - Select One (required)

*To Register for the Global Friendship Program Please Use the Separate Forms:
Application Form for Students/ Visiting Scholars
Application Form for Host & Family

Country of Origin

Gender  MALE FEMALE

Age

*If under 18, a parent or legal guardian must be present for the duration of the program.

ECIR Resident  YES NO

Please Select One
 Student* Visiting Scholar Community Member

*If you checked Student, please indicate which university you're currently attending

Field of Study or Occupation

Food or Dietary Restrictions

Allergies/Medication

Emergency Contact

Name

Email

Phone Number

Please Share With Us Why You Are Interested in this Program

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