TRANSPORTATION AND CRITICAL INFORMATION FORM

Name _________________________Email: __________________Cell Number (____)_____________

COMPLETE AND RETURN TO womenctr@duke.edu by July 10th.

Transportation Information:

Please fill out this form to let us know when to expect your arrival. If you are flying into RDU on the 10th, Project
Change can try to arrange for you to share a cab with another Project Change student. All participants must arrive
by 3:30pm on Monday, August 10th.

I expect to arrive at the Duke University Women’s Center to check in for Project Change on August 10h 2008 at
________ AM/PM via (one of the following):

1. Taxi from RDU airport to Duke University. My flight # is ____________ on ______________________ airline
arriving at Raleigh/Durham airport (RDU) at _________ AM/PM, August _____, 2009. (A taxi from RDU to
Duke’s East Campus will take from 20-30 minutes and should cost around $35-40, tip included).

2. Private car arriving at Duke’s West Campus at ________ AM/PM, August ___, 2009

3. Other: ___________________________________________________________________________

If you are interested in carpooling with another participant from your area or from RDU, please contact us. We will
provide you with appropriate names, emails and phone numbers. If you wish that your contact information not be
shared with other participants for the purpose of carpooling arrangements, please check here: _____
Date to leave: ________________
Address you’ll be leaving from: ___________________________________________________________________
_____________________________________________________________________________________________

IF YOUR TRANSPORTATION PLANS SHOULD CHANGE, PLEASE LET US KNOW IMMEDIATELY.

Other Necessary Information:

T-Shirt: Women’s Size________ or Men’s Size________

Are you a vegetarian, vegan, do you keep kosher or have any other dietary restrictions? Please be as specific as
possible:
_____________________________________________________________________________________________
_____________________________________________________________________________________________

Do you have any allergies? Please let us know even if you’ve already provided this information on another form.
_____________________________________________________________________________________________
_____________________________________________________________________________________________

Will you need to take any medications while at Project Change or do you have any other physical conditions that
may affect your experience? Since we will have a busy schedule, we want to ensure that your needs will be taken
care of regardless of where we are. If you have medications that need to be refrigerated, taken at regular intervals,
etc, please let us know even if you’ve provided this information on another form. This information will be kept
confidential.
_____________________________________________________________________________________________
_____________________________________________________________________________________________

Emergency Contact Name ________________________________

Emergency Contact Relation to you _________________________
Emergency Contact Number (______)_______________________
Emergency Contact E-mail_________________________________