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AUG 2 3 2023 SISTER CITY 55t6 ANNIVERSARY
VISIT TO OBIHIRO, JAPAN
OFFICE OF THE
CITY CLERK APPLICATION
Applicant Name: I ��/�C.f Date: 9//v/z 3
Physical Address: Z 1 Q —b111_tP -11L, 7�t4 cd /q6&4
Phone: CV7— E-Mail: '��QA�X1'4y-(y �l'hy_4-k4 F&,A7 i2►Lou.`
As an applicant for this event, I understand and accept the following:
• There are some financial obligations relating to travel and gifts that will be borne by me, and
• I am at least 18 years of age; and
• I am willing to accept the time commitment involved, including attending a mandatory orientation
session prior to travel; and
• There may be other scheduled activities sponsored by the City of Obihiro which require my future
participation in order to promote the event; and
• While in Japan, I will be living in a "home stay"environment with a Japanese family as their guest;
and
• The dates of this event will be approximately October 26, 2023, through November 2, 2023; and
• This event may also include an additional visit to Kushiro,Japan (Seward's Port City)
• While involved in this program, I will represent the City of Seward in the best possible manner.
Upon returning to Seward, I accept my commitment in this exchange program further involves me to:
• Provide the City Clerk's Office with at least five (5) photographs of my experiences in Japan,
labeled with names and events, within two months of my return; and
• Potentially share my experiences publicly by speaking at a community gathering, and/or writing an
article about my experiences (possibly a joint effort with other participant) that may be distributed or
published in a local newspaper; and
• Review any materials provided by the City of Seward to familiarize myself with Japan and the area I
will be visiting.
I understand that the City of Seward does not cover medical or liability insurance for this exchange. I
hereby waive on behalf of myself any liability responsibilities of the City of Seward for injuries or damages
sustained in this exchange program. I also understand that medical, liability, and/or travel insurance are my
responsibility.
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licant) (Date)
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1) What are your special interests as they relate to Japan?
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2) What community activities do you currently participate in or have you participated in in the past that
may be relevant to this event?
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3) How well do you know the Japanese language and/or culture?
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4) Why do you feel that you would be the best representative of Seward tog ap J to ' an�(;:��
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5) Do you have any potenti onflicts with the proposed dates?
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6) Are you capable of fully funding your travel?
7) Do you have a current, valid passport? You will be required to submit a copy to the Clerk's ice if
selected. �P-5
8) Have you ever attended a visit to one of our Sister City's as a delegate representing the City of
Seward in the past?If so, when? T,)D .
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