Southern Adventist University ~ School of Religion
2016 Fall Adventist Heritage Tour Application
October 19 - 24, 2016
Return to Mary Anne Poulson in Hackman Hall 211 no later than September 12.
Name ______________________________________ ID # ________________ Age ________
Physical Address ______________________________________________________________
Mailing Address _______________________________________________________________
Cell Phone _____________________ E-mail ______________________ Date ____/____/____
Trip Option # ________
All deposits and fees may be paid in cash, money order, or check made payable to
Southern Adventist University.
Option #1 - Register for one hour of credit – RELT 139 Adventist Heritage Tour. Lab fee #16
($500) will be charged to your Southern statement to cover the cost of the trip. You also need to pay a
$50 advance deposit to Mary Anne Poulson by September 12 that will be returned to you in cash on the
bus. See Catalog for course requirements. Total trip cost is $500 (plus one-hour tuition cost if you are
registered for more than16 credit hours.)
Option #2 - Go on the trip as a part of your learning experience in RELT 138 Adventist
Heritage class. Do the assignment/project specified by the Adventist Heritage teacher to fulfill the
class requirement. Pay the deposit of $50 by September 12 to reserve your place on the bus. Pay
$450 to Mary Anne Poulson by October 1. Total trip cost is $500.
Option #3 - Go on the trip to enjoy the fellowship and personal learning experience. Pay the
deposit of $50 by September 12 to reserve your place on the bus. Pay $450 to Mary Anne Poulson by
October 1. Total trip cost is $500.
All tour participants must pay a $50 deposit to reserve a seat on the bus. This deposit
must be paid by Monday, September 12. The $50 deposit is refunded in cash on the bus
to students who have registered for RELT 139.
In case of emergency, contact the following person:
Name ___________________________________________________________________
Relationship ______________________________________________________________
Phone Number(s)__________________________________________________________
List all medications you are currently taking or special diet (diabetic, gluten-free, vegan, etc.) you require.
___________________________________________________________________________
___________________________________________________________________________
I understand that I am a representative of Southern Adventist University while on this tour and will
conduct myself in a manner that harmonizes with the standards of the SAU Handbook and Catalog. All
information I have given on this application is true and accurate to the best of my knowledge.
Signature ____________________________________________
Date _____________________