2024 Student Registration Form
Fill out the form carefully for registration
Student Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
-
Country Code
-
Area Code
Phone Number
Age
*
Please list your age at the time you be participating in the program.
Will you be using our housing? (Must be 18 years old)
*
Please Select
Yes
No
If you are using CMERA housing, please list your gender
*
Please Select
Female
Male
Not Using CMERA Housing
Roommate Requests (First and Last Name)
T Shirt Size
*
Please Select
Small
Medium
Large
X Large
XX Large
How did you hear about our program?
Please Select
Professor / Advisor
I am a past attendee
Referred by a past attendee
Social Media
Saw a poster at School
E-mail Ad
Deferred from 2022
Other
Emergency Contact
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
School
Deposits / Number of Weeks Selected
*
One Week Deposit $249 - Research Scientist
Two Week Deposit $498 - Research Scientist
Three Week Deposit $747 - Research Scientist
Four Week Deposit $996 - Chief Scientist
Five Week Deposit $1245 - Chief Scientist
Six Week Deposit $1494 - Chief Scientist
Seven Week Deposit $1743 - Chief Scientist
Eight Week Deposit $1992 - Intern Trainee & Chief Scientist
Nine Week Deposit $2241 - Intern Trainee & Chief Scientist
Ten Week Deposit $2490 - Intern Trainee & Chief Scientist
Eleven Week Deposit $2739 - Intern Trainee & Chief Scientist
Twelve Week Deposit $2988 - Marine Biologist Trainee & Chief Scientist
Thirteen Week Deposit $3237 - Marine Biologist Trainee & Chief Scientist
Fourteen Week Deposit $3486 - Marine Biologist Trainee & Chief Scientist
Fifteen Week Deposit $3725 - Marine Biologist Trainee & Chief Scientist
Sixteen Week Deposit $3984 - Marine Biologist Trainee & Chief Scientist
Weeks Requested: NOTE Weeks 3-7 are now full
*
Week # 1 May 5-11, 2024
Week # 2 May 12-18, 2024
Week # 8 June 23-29, 2024
Week # 9 June 30 - July 6, 2024
Week # 10 July 7-13, 2024
Week # 11 July 14-20, 2024
Week # 12 July 21-27, 2024
Week # 13 July 28 - August 3, 2024
Week # 14 August 4 - August 10, 2024
Week # 15 August 11 - August 17, 2024
Week # 16 August 18 - August 24, 2024
Medical Restrictions / Dietary Needs
This is used for informational and safety purposes and will not affect your acceptance into the program.
Back
Next
Deposits - Please pay a deposit for each week you are attending. This deposit is NOT the total program fee of $949 per week, it is a deposit to secure your spot in the weeks you are requesting. The deposit is subtracted from your total and the total balance is due thirty days after your registration.
prev
next
( X )
Weekly Deposit
$
249.00
Number of Weeks
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Credit Card
First Name
Last Name
Credit Card Number
Security Code
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
Expiration Year
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
By submitting this application you acknowledge you have read and understand our refund policy. Additionally, you acknowledge you will be required to sign a housing agreement to utilize our housing and must also sign a liability waiver to participate in any program activities. You also acknowledge that the program fee is $949 per week, and your deposit will be applied toward your total program fee balance. Housing, if needed, is an additional $345 per week which is also due March 31.
*
I agree
Clear Fields
Submit Application
Should be Empty: