SFPD Sojourn Enrollment Form (Feb 26-March 2 )

Pepperdine Sojourn Enrollment Form (February 26 - March 2, 2022)

Please fill out completely.
Participant Name *

First Name Last Name
Participant Legal Name (For Flights) *

First Name Last Name
Birthdate (mm/dd/yyyy) *

Month Day Year
Date
Gender Identification - Please type M or F or how your prefer to self-describe as: *
Participant Email *
example@example.com
Participant Phone Number *
Please enter a valid phone number.
Complete Home Mailing Address (Number, Street, Apt #, City, Zip) optional

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Waivers

Permission is granted to include photographs and videos taken of particiapant in marketing and informational material produced by Sojourn to the Past. Sojourn to the Past also has the right to reproduce in whole or in part essays or after writings by participant during the journey.

Your signature below acknowledges that you have read and agree to the waivers policy.
Participant Signature *

Clear
Date *

Month Day Year
Date
Should be Empty:

Pepperdine Sojourn Enrollment Form (February 26 - March 2, 2022)