SPRING 2007 – TRAVEL ABROAD
PARTICIPANT INFORMATION FORM
Faculty Contact: Dr. D.K. Malhotra, School of Business Administration; 215-951-2813
Your name *:
Previous name(s)*:
Name to appear on name tent:
Phone, home:
Phone, office:
E-mail address:
Birth Date:
Years of College *:
Name of next of kin or person to contact in emergency:
Phone and address of kin (if different from yours), and e-mail address:
Country of passport:
Passport number:
Visa number (if appropriate):
Social Security number:
Fluency in language(s) other than English:
Meal preferences (circle one)*:
Chicken
Vegetarian
Kosher
Please include any other names used if you’ve changed your name (for marriage, or other
reason). You MUST use the same name on your all travel documents (passport,
visa, airline and other tickets, reservations, etc.). If you do not, you may be delayed or
denied entry or exit from a country.
 Please use the following for completed degrees. BA/BS = 4 years; MA/MBA = 1.5 years;
Ph.D. = 5 years. If you’re about half-way through the MBA, use 1 year for the MBA, and 4
years for BA.
 Meal preferences can be accommodated at welcome dinner only. If choices are available at
other times, I will use your selection to guide me at those times as well. Our corporate
hosts usually, but not always offer a vegetarian or non-meat option. Please make your
preferences known to Accent for in-flight meals.
 Return this form no later than January 10, 2007. You need to have your passport
in hand by that date, so plan accordingly.

PLEASE ATTACH A COPY OF YOUR PASSPORT AND VISA PAGES THAT INCLUDE
YOUR PHOTO, PASSPORT AND VISA NUMBER, AND OTHER VITAL INFORMATION .
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International Business Trip
Assumption of Risk and Release Form
I. Personal and Academic Conduct: If I fail to meet Philadelphia University’s1 standards of
scholarship and character, and/or my behavior is determined to impede or obstruct the
progress of University-sponsored study abroad programs, I expressly acknowledge the right of
Philadelphia University to require immediate withdrawal from University-sponsored programs
at any time, even overseas, at the sole discretion of Philadelphia University.
I will remain enrolled concurrently as a degree candidate at Philadelphia University while
studying abroad. I recognize that it is my responsibility, before departing for my assignment,
to consult with my academic advisor concerning courses to be taken abroad.
While studying abroad, I agree to adhere to the University's Student Code of Conduct and all
other applicable rules and regulations of Philadelphia University. I understand that violation
of academic or disciplinary guidelines may constitute grounds for my expulsion from the
program and may incur action by the Student Conduct Committee.
Illegal Drugs: I understand that the use or possession of illegal drugs during the
program is cause for immediate dismissal without refund.
Involuntary Withdrawal: I acknowledge that return passage and all other expenses
occasioned by my involuntary withdrawal from the program shall be my sole and
exclusive financial responsibility.
II. Corporate Visit Attendance: I will comply with the program attendance policies of
Philadelphia University. I understand that I am expected to invest, at minimum, the same
amount of time and effort in my classes abroad as is required at home.
III. Notice of Withdrawal: I agree to notify Philadelphia University in writing should I choose to
withdraw from the study abroad program. Only that portion of my tuition and fees which has
not been committed on my behalf at the time of my written notice of cancellation will be
refunded to me. If I withdraw before paying my tuition and fees, I acknowledge Philadelphia
University's right to bill me for financial commitments made on my behalf, and acknowledge
my responsibility for costs incurred.
IV. Emergency Medical Treatment: As a participant in the Philadelphia University Study
Abroad Program, I authorize in advance representatives of the host university abroad to
secure whatever emergency medical treatment is necessary, including the administration of
an anesthetic and surgery.
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International Business Trip
Assumption of Risk and Release Form
V. Medical Insurance and Medical Notification: I agree to comply with Philadelphia
University's requirement that all of its study abroad participants be covered by its Study
Abroad medical insurance policy.2 I agree to notify the University's Study Abroad Office of any
pre-existing medical or psychological condition that could adversely impact my participation in
the Study Abroad Program. If required by the University to participate in the Study Abroad
Program, I agree to obtain a release form from a medical or psychological professional.
VI. Philadelphia University's Right to Cancel or Change Programs: I understand that
although the University will attempt to maintain programs as described in its publications and
brochures, it reserves the right to change programs, including the itinerary, travel
arrangements, or accommodations, at any time and for any reason, with or without notice.
Further, I understand that Philadelphia University reserves the right to cancel study abroad
programs due to insufficient participation or other reasons.
VII. Students with Disabilities: I acknowledge that the absence of law mandating equal access
for individuals with disabilities in some countries may affect the University's ability to provide
reasonable accommodations in certain locations. Disclosure of any disability to Philadelphia
University will ensure that every effort is made to provide access to study abroad locations
and to request reasonable accommodations for a disclosed disability.
VIII. Orientation: Pre-departure orientation literature will be provided during the semester
immediately prior to, as well as the semester of the Study Abroad. I agree to read this
material.
IX. Release from Liability: I acknowledge that travel abroad has inherent risks and that
Philadelphia University cannot monitor or control these risks. Accordingly, I agree that
Philadelphia University, its officers, employees, agents and representatives shall not be liable
for any claims, demands, or causes of action based upon or arising out of any illness or injury
(including death), property loss or damage, deviation, delay or curtailment, however caused,
which I may suffer in connection with enrollment or participation in any of Philadelphia
University's sponsored study abroad programs.
X. Indemnification: I indemnify and hold harmless Philadelphia University, its officers,
employees, agents and representatives from any and all claims, demands, and causes of
action and all expenses incidental thereto (including reasonable attorney's fees), based upon
or arising out of any illness or injury (including death), property loss or damage, deviation,
delay, or curtailment caused by or resulting from my acts or omissions during enrollment in
any of Philadelphia University's sponsored study abroad programs.
XI. STUDENT SIGNATURE: I have read carefully the Assumption of Risk and Release Form and
understand its contents. I agree to comply with all its provisions.
Student Name:
Student Signature:
1
2
Student ID#:
Date:
Abbreviated "University" and "the University" in this document.
The Assistant Vice President for Business and Finance may make exceptions to this policy.
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