2025 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
Number of Weeks Selected
*
Please Select
One Week - Research Scientist
Two Weeks - Research Scientist
Three Weeks - Research Scientist
Four Weeks - Chief Scientist
Five Weeks - Chief Scientist
Six Weeks - Chief Scientist
Seven Weeks - Chief Scientist
Eight Weeks - Intern Trainee & Chief Scientist
Nine Weeks - Intern Trainee & Chief Scientist
Ten Weeks - Intern Trainee & Chief Scientist
Eleven Weeks - Intern Trainee & Chief Scientist
Twelve Weeks - Marine Biologist Trainee & Chief Scientist
Thirteen Weeks - Marine Biologist Trainee & Chief Scientist
Fourteen Weeks - Marine Biologist Trainee & Chief Scientist
Fifteen Weeks - Marine Biologist Trainee & Chief Scientist
Sixteen Weeks - Marine Biologist Trainee & Chief Scientist
Weeks Requested:
*
Week #1 April 27 May 3, 2025
Week #2 May 4-10, 2025
Week #3 May 11-17, 2025
Week #4 May 18-24, 2025
Week #5 May 25-31, 2025
Week #6 June 1-7, 2025
Week #7 June 8-14, 2025
Week #8 June 15-21, 2025
Week #9 June 22-28, 2025
Week #10 June 29 - July 5, 2025
Week #11 July 6-12, 2025
Week #12 July 13-19, 2025
Week #13 July 20-26, 2025
Week #14 July 27 - August 2, 2025
Week #15 August 3-9, 2025
Week #16 August 10-16, 2025
Week #17 August 17-23, 2025
Week #18 August 24-30, 2025
Medical Restrictions / Dietary Needs
This is used for informational and safety purposes and will not affect your acceptance into the program.
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Deposits - Please pay a deposit for each week you are attending. This deposit is NOT the total program fee of $849 per week (early registration) or $949 (late registration), 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 for early registration is due prior to December 31, 2024 and for late registration, March 31, 2025.
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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 $849 per week for early enrollment as long as you pay your balance IN FULL prior to Dec 31, 2024 after that time it will be at the late enrollment rate of $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, 2025.
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