1. Name as shown on passport , , ,
2. Name as you would like it on your nametag ,
3. Do you already have a Friendship Force nametag? ?YesNo
4. Street Address ,
    City , State , Postal Code , Country ,
5. Telephone: Home , 6. Work , 7. Fax: , 
8. E-mail: ,
9. Date of Birth: , 10. Birthplace ,
11. Sex: - ? -MaleFemale, 12. Marital Status: - ? -MarriedSingle, 13. Do you have a valid passport? -?-YesNo,
14. Passport Number , 15. Expiration Date ,
16. Please note any languages you speak other than your own and your proficiency in that language.
Language , Proficiency -?-ExcellentGoodFairPoor, 
Language , Proficiency -?-ExcellentGoodFairPoor,
17. Current Job Title and Employer (previous job if retired): 
,
18. Please give a short description of your work responsibilities (previous job if retired):
19. Interests and Hobbies - Choose no more than three:
Outdoor Activities, Antiques, Sports, Museums, Theater/Movies, Cooking, 
Animals, Music, Entertaining, Crafts, Volunteer Work, Dancing, Gardening/Farming, 
Family Activities, Reading, Photography, Traveling, Collecting-Stamps/Coins, Art, 
Other ,
20. Please choose where you have previously traveled: Africa, Asia, Europe,
Latin-America, Middle-East, North-America, Russia/NIS, South-Pacific, None.
21. Have participated in a home stay (or similar) program before: 
As a host -?-YesNo, As a visitor -?-YesNo,
22. Are you currently a member of a Friendship Force Club: -?-YesNo
If so, which one?
23. Do you smoke? -?-YesNo
24. Participation in a Friendship Force home-stay often requires a greater level of physical activity than a person is accustomed to, such as carrying luggage, climbing stairs, riding public transportation, and walking long distances, among others.  List all physical limitations you have that should be taken into consideration: ,
25. Do you have any allergies or particular diet, health, or medical conditions that require special consideration? -?-YesNo,
If yes, please specify  
(i.e., allergy to penicillin or animals, vegetarian, high blood pressure, recent surgery)
For their own safety precautions, Ambassadors may be required to provide supporting medical documentation.
26. If traveling with another person please complete the following.  Each applicant should submit an application.
Name ,Relationship ,Age ,
Name ,Relationship ,Age ,
Name ,Relationship ,Age ,
27. Ambassadors under 18 must travel with a parent or guardian.  Ambassadors under 16 must be hosted together with a parent or guardian.
Name of guardian for youth under 18:
28. Person at home to contact in case of emergency: Relationship:  
(name) (address) (city-state-zip/postal code)        Telephone: Home , Work ,

Personal Mission Statement:

The Friendship Force considers each Ambassador and Host to be a "Citizen Diplomat," a person committed to improving international relations through people-to-people diplomacy during and after the exchange.
To help judge your application, please write briefly in the space below a personal goal that you wish to accomplish through this exchange. It can be a spin-off project (i.e. establishing a sister-school link), a special connection (arranging a return visit by a musician or artist), or just making a lifelong friend. Think about how you can keep these personal and institutional relationships alive after you return home and share your goals with us here:

I have read the Ambassador Agreement provided with this Application and accept its terms.  I hereby agree to secure adequate travel and medical insurance for the duration of the exchange.  I certify that I am 18 years of age or older and have completed this application to the best of my knowledge and believe it is true.

Signature of Ambassador or Guardian (if Ambassador is under 18 years old, both signatures are required)
,
Date    ENTER THE EXCHANGE NAME HERE: 

© The Friendship Force of Los Angeles

THE FRIENDSHIP FORCE

AMBASSADOR APPLICATION AND AGREEMENT

The Friendship Force, Inc. ("The Friendship Force") was founded in 1977 with a single mission: to create an environment where personal friendships are established across the barriers that separate people.  A nonprofit organization, The Friendship Force is active in more than 50 countries, promoting friendship and goodwill through an extensive program of homestay exchanges.  In consideration of his/her selection, the person signing this Agreement ("Ambassador") agrees to the following:

1. The Program Fee entitles the Ambassador to participate in a specific exchange and covers only the items specified in the itinerary.  The schedule of payment of Program Fees must be observed.

2. The Ambassador recognizes that connected with any travel there are risks of loss, damage, and injury to persons and property, and the Ambassador is willing to assume and bear those risks.  The Ambassador also recognizes that he/she is responsible for failure to comply with any law of any country visited.  Therefore, the Ambassador, in consideration of his/her selection by The Friendship Force, agrees to and does hereby release, indemnify, and hold harmless The Friendship Force (which shall include the directors, officers, and employees thereof, as well as its volunteer workers) from all claims, actions, and causes of action based upon or by reason of any loss, damage, or injury to the Ambassador's person or property, arising out of or in any manner connected with any aspect of the exchange program or by reason of the Ambassador's failure to comply with any law in any country in which he/she may travel in connection with the exchange program.  The Friendship Force shall have no liability or obligation to return the Ambassador to his/her home community if the Ambassador should miss the return trip due to illness, injury, failure to report to the airport at the prescribed time, or for any other reason.

3. All Friendship Force Ambassadors are required to secure adequate travel and medical insurance to cover emergencies during the exchange.  No travel, health, or accident insurance is provided by The Friendship Force, although one may be recommended. This requirement can be fulfilled through the Ambassador’s existing insurance policy if it covers international travel, including emergency repatriation, or through a separate travel insurance policy.  All travel will be subject to regulations and limitations contained in the ticket(s) issued to the Ambassador.

4. Any request for cancellation of this agreement must be made in writing to the local Exchange Committee and forwarded to Friendship Force International.  If an Ambassador cancels 45 days or less prior to departure FFI will refund 50% of the FFI Fee paid.  If FFI cancels an exchange, all FFI fees paid will be returned to Ambassadors. 
In case of cancellation due to illness or death of an Ambassador or an immediate family member, Friendship Force International may require a medical doctor's certificate and airline ticket to process the refund.
If this agreement is not for a club-to-club exchange, please consult your Program Coordinator for cancellation and refund policy.

5. The Friendship Force may cancel this agreement if it is unsuccessful in establishing an exchange which satisfies the goals of The Friendship Force for any reason, including cancellation of or unacceptable changes to the airline arrangements or failure of the local committee to recruit the required number of Ambassadors.  In such cases, all of the Program Fee will be refunded except the $25 portion designated as non-refundable.

6. If Friendship Force International is making travel arrangements for your exchange, any price increase for transportation will be passed on to the Ambassador until the time that the full Program Fee is received at the international office of Friendship Force International in Atlanta, Georgia, USA.  After that time, no increase will be passed on to the Ambassador, except in the case of carrier or routing changes beyond the control of Friendship Force International.

7. The Friendship Force Ambassador hereby agrees to follow the provisions stated above and: a) to attend training workshops, b) to accept travel arrangements as arranged by The Friendship Force, c) to participate fully in the homestay, d) to pay the Program Fee when due, e) to accept the decision making authority of the Exchange Director during the exchange, and f) to accept that the exchange is a public event and that the photograph and name of the Ambassador may be used by the local and national media and The Friendship Force in its publications.

8. Upon acceptance of the Ambassador into the exchange program, this Agreement shall become effective and binding upon The Friendship Force and the Ambassador, and shall be governed by the laws of the state of Georgia, USA.  No representations, or statements, whether oral or written, other than those contained herein, shall be binding on The Friendship Force.  In the event the Ambassador fails to abide by any of the terms and conditions of this agreement, The Friendship Force may terminate this Agreement without any penalty or liability to The Friendship Force.

Ambassador Pledge: I agree to be an Ambassador of goodwill to the country I am visiting and I agree to live in the home assigned to me knowing that the standards of that home may be different from my own and that the host family has a culture or language different from my own.  If home hosting is not available, I understand that I will be traveling for the purpose of extending friendship to the citizens of my host country.

Signature of Ambassador or Guardian (if Ambassador is under 18 years old, both signatures are required)
,
Date    ENTER THE EXCHANGE NAME HERE: 

Please fill in this form, then print this form, then sign it, and finally mail it to your Exchange Director.

This page last modified September 13, 2008.