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* 1. Traveler Name (Last Name, First Name, Middle Inititial)

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* 2. Traveler Email

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* 3. Traveler Cell Phone Number

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* 5. Name of university/institution employed by

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* 7. If traveling to Toolik, please provide the mode of transportation to Toolik Field Station

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* 8. Arrival date to Fairbanks, AK

Date

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* 9. Intended departure date from Fairbanks AK [note that 14 full days are required]

Date

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* 10. Do you want CPS to provide a PPE kit for your travels?

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* 11. If Yes, please provide a mailing address.

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* 12. Are you interested in attending a remote Arctic Field Training while you are in quarantine?

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* 13. Emergency Contact (Name and phone number)

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* 14. Please add any other information in the box below

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* 15. By clicking this box I understand that CPS will be obtaining COVID test results. I agree that they can share this health information with me via email.

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