Board Members and Advisors Travel Form Board Members and Advisors Travel Form This is a secure form. Once you have started entering your information, please do not navigate away from the page until you have completed and submitted the form. The form will not save your information, and we don't want you to have to enter it more than once! Name* First Last Home Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email* Primary Phone Number*Alternate Phone NumberHow would you describe your general health?*ExcellentGoodFairPoorDo you have any known allergies?*YesNoPlease list your allergies.Dietary Restrictions*Our hosts in Ghana can provide vegetarian options; however, if you have other dietary restrictions, you will need to pack your own food for two weeks.I have no dietary restrictions.Vegetarian: I understand that NEA can provide limited vegetarian options.Other (vegan, gluten-free, dairy-free, nut-free, etc.): I understand that NEA cannot accommodate my diet and agree to pack appropriate food and/or supplements for the two weeks.When does your passport expire?*I don't have a passportIt expires BEFORE February 28, 2023 (next year).It expires AFTER February 28, 2023 (next year).Passport Update Needed*Travel visas to Ghana cannot be issued if your passport expires within 6 months from the last day of the mission. Your passport expires before that deadline. Please confirm that, should you be accepted, you will renew your passport by June 15, 2022. I agree that I will renew my passport before Wednesday, June 15, 2022. Passport Needed*Please confirm that, should you be accepted to the team, you will secure a valid passport by Wednesday, June 15, 2022. I agree that I will obtain a valid passport by Wednesday, June 15. Please provide a copy of your passport*Additional Information (Optional)You may use this space to share any additional information about yourself.Confirm that you understand and accept the Security & Safety Guidelines and Waiver & Release.*Please read the Safety & Security Guidelines and Waiver & Release. I have read the Safety & Security Guidelines and Waiver & Release and I am willing to abide by them. Please upload a copy of the signed Waiver & Release.*PhoneThis field is for validation purposes and should be left unchanged. Δ