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CONFIRM
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PAYMENT


Applicant / Passport Information

September 2020
SuMoTuWeThFrSa
303112345
6789101112
13141516171819
20212223242526
27282930123
45678910
?
September 2020
SuMoTuWeThFrSa
303112345
6789101112
13141516171819
20212223242526
27282930123
45678910
?
September 2020
SuMoTuWeThFrSa
303112345
6789101112
13141516171819
20212223242526
27282930123
45678910

Other Citizenship / Nationality



Personal Information

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Contact information of the applicant




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Enrollment in the GE Program?


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Travel information
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Information for emergency contacts outside the United States



Eligibility Information










WAIVER OF RIGHTS

I acknowledge my waiver, during the entire period of validity of the authorization granted to me by ESTA, to any right regarding the review and any appeal relating to the decision of a States Customs and Border Protection United on my eligibility, or on an appeal against a return action resulting from an application for admission under the Visa Waiver Program, except for applications for political asylum.

In addition, as a condition for my admission to the United States under the Visa Waiver Program, I agree that submitting my biometric data (including fingerprints and photographs) upon my arrival in the United States constitutes a reaffirmation of my waive any right regarding the review and any appeal relating to a decision by a United States Customs and Border Protection agent on my eligibility, or an appeal against a return action resulting from a request for admission to the under the Visa Waiver Program, except for political asylum requests.


CERTIFICATION:

FOR THIRD PARTIES:

Disclosure
I, the applicant, declare that I have read, or that someone has read me, all the questions and declarations on this form and that it has understood all the questions and declarations on this form. The answers and information provided in this question are true and correct, as far as I can know and believe.

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