UJA-FEDERATION OF NEW YORK MISSIONS APPLICATION
|
|
- Paul Lindsey
- 5 years ago
- Views:
Transcription
1 UJA-FEDERATION OF NEW YORK MISSIONS APPLICATION TECH MISSION TO BERLIN & ISRAEL IN CONJUNCTION WITH THE ISRAEL ECONOMIC MISSION, MINISTRY OF ECONOMY, GOVERNMENT OF ISRAEL WEDNESDAY, NOVEMBER 8 FRIDAY, NOVEMBER 17, Please reserve space(s) for the mission. I am paying a deposit of $ at $1000* per person. My check is enclosed. Please charge my: MasterCard Visa American Express Discover I hereby authorize UJA-Federation of New York to charge my credit card provided below. I understand that these payments are necessary in order to reserve my trip. I further recognize that these payments are for services (hotels, meals, and so forth) and are not charitable contributions. Please see costs sheet for full details. Any further charges while you are abroad will be charged to your card after you return. on Credit Card Signature Billing Address Card # Exp. Date *The $1000 deposit per person will be charged on receipt of your application. There will be a 2 nd installment of $2500 charged within two weeks of receipt of your application. The remaining cost (as set forth on the costing) will be charged days before departure. All other charges, including, but not limited to, charges incurred subsequent to the start of the mission, such as incidentals, deviation fees, differences in airfare caused by a change in the participant s flight or itinerary, will be charged after the conclusion of the mission. You may pay by check, but note that all payments must coincide with the payment schedule. 2. (s) LIST FIRST, MIDDLE AND LAST NAMES EXACTLY AS THEY APPEAR ON YOUR PASSPORT. If there is any discrepancy between the names listed here and the names on your passport, your airline ticket may not be valid and you may have a problem at the airport. Passport must be valid for six months past the return date of this mission. Mr. & Mrs. Mr. & Ms. Mr. Mrs. Ms. Other: Principal (FIRST, MIDDLE AND LAST NAMES MUST BE EXACTLY AS WRITTEN ON PASSPORT) First Middle Last (please specify) Passport # Issue Date (m/d/y) Place of Birth Place of Issue and Citizenship Expiration Date (m/d/y) Date of Birth (m/d/y) Spouse/Guest (FIRST, MIDDLE AND LAST NAMES MUST BE EXACTLY AS WRITTEN ON PASSPORT) First Middle Last Passport # Issue Date (m/d/y) Place of Birth Place of Issue and Citizenship Expiration Date (m/d/y) Date of Birth (m/d/y) Relationship to Principal 1
2 3. Home Information Street Apt. City State Zip Phone Cell Fax (s) Business Information (principal) Profession Title Firm Street Floor/Suite City State Zip Phone Fax Business Information (spouse/guest) Profession Title Firm Street Floor/Suite City State Zip Phone Fax Please specify your primary mailing address: home business (principal) business (spouse/guest) 4. Medical Information (required for each participant listed on application) (Rating guide: 1 = poor walker; 2 = difficulty with distances or steps; 3 = fairly comfortable; 4 = average walker; 5 = walks with ease; 6 = able to hike) Health Issues Medicine Rate your level of mobility: Health Issues Medicine Rate your level of mobility: IMPORTANT: HEALTH INSURANCE IS NOT PROVIDED FOR MISSION PARTICIPANTS. If you want to be insured for medical care during the mission you must make your own arrangements we suggest checking possible coverage by your current insurance first. 5. Emergency Contacts (required) Business Phone Relationship to Participant(s) Home Phone Cell Phone Relationship to Participant(s) Business Phone Home Phone Cell Phone 6. Flight Arrangements Mission programming will begin at 10:30am on November 9 th in the lobby of the Berlin hotel and will conclude following dinner on Thursday, November 16 th. Participants are responsible for booking all international flights. We wish to be contacted for assistance with flights (Claude Hakim, Field Travel: , mrfield@verizon.net) We will arrange our own flights. We have attached our flight itinerary (required): 2
3 7. Religious Background (required for each participant listed on application) Are you Sabbath Observant? Yes No Do You Use Transportation on Shabbat? Yes No Dietary Restrictions: Kosher? Yes No Vegetarian? Yes No Vegetarian, will eat fish? Yes No Are you Sabbath Observant? Yes No Do You Use Transportation on Shabbat? Yes No Dietary Restrictions: Kosher? Yes No Vegetarian? Yes No Vegetarian, will eat fish? Yes No 8. Rooming Arrangements Standard rooms have been reserved at the Titanic Hotel in Berlin and the Hilton Hotel in Tel Aviv. Please contact Susan Flanders or ) to discuss pricing and availability of rooms/suites in other categories. Variances in cost will be detailed on your bill. All costs subject to confirmation and booking. Please select a type of room: Single room (additional single supplement will apply) OR Double room I would like to room with (if other than spouse/guest) If possible, please arrange for non-smoking room I will arrive and/or depart before/after the mission dates. Please arrange my hotel reservation(s) as follows: (additional costs will apply) Check in: (date/time) 3 Check out: (date/time) 9. Airport Transfers Airport transfers for those participants on the majority flights, TBD, will be available at no additional cost. Individual transfers and VIP airport service (Tel Aviv only) may be arranged at an additional cost and will be added to your bill. Costs will be confirmed as services are requested. Smaller groups of participants arriving and/or departing on the same flight(s) will be transferred together and costs will be divided. Please arrange for transfers. All flight details must be provided in section 6. Please select as many as required. Transfer from the Berlin airport to the mission hotel. Exact meeting point TBA Transfer from the Tel Aviv mission hotel to the airport. You will be at the airport 3 hours before your flight if economy or 2 hours before your flight if business/first class. Other If you would like to be dropped off or picked up at a place other than the hotel, specify the exact address and times. Pick up from: Transfer to: Date: Contact number (required): Time:
4 10. PHOTO/IMAGE RELEASE I hereby grant the permission, without reservation, to UJA-Federation of New York to take and to use photographs and/or sound/image recordings of me to describe and to use the same for promotion of good will, public education, and/or fundraising and other related activities of UJA-Federation of New York, and I waive any right to inspect or approve the photograph(s) or finished version(s) of works, including a website, incorporating the photograph(s). I release UJA-Federation of New York and its officers, trustees, agents, employees, independent contractors, licensees, and assignees, including photographers, from all claims I may have or might have for any cause of action arising out of taking and/or use of the photographs and/or any sound/image recordings, and/or descriptions of the same, be it blurring, distortion, alteration, optical illusion, or use of a composite, whether intentional or otherwise, that may occur or be produced in the taking of photographs, or any processing toward the completion of the finished product, unless it can be shown that they and the publication thereof were maliciously caused, produced, and published solely for the purpose of subjecting me to conspicuous ridicule, scandal, reproach, scorn, and indignity. I recognize that UJA-Federation of New York owns the copyright (or may apply for the copyright) of these photographs and other works and creations, and I hereby waive any claims I may have based on any usage of the photographs or works derived therefrom in any form, whether it be printed, projected, televised, or transmitted via the Web, or/and at anytime, be it in the present or in the future, including, but not limited to, claims for either invasions of privacy or libel. I am of full age and competent to sign this release. I agree that this release shall be binding on me, my legal representatives, my heirs, and my assigns. I have read this release, and I fully understand its contents. 11. SECURITY NOTICE AND DIRECTIVES TO MISSION PARTICIPANTS UJA-Federation of New York is vitally committed to the people of Israel and Jewish communities worldwide. We have pledged to stand with the people of Israel and other communities during the trying days of the current crisis and terrorist violence by continuing to send missions to Israel and elsewhere. You have expressed your own commitment and love for the people of Israel and other communities by your deciding to join us, and we are deeply grateful. We are committed to providing you a meaningful mission experience. Toward this end, the itinerary of every UJA-Federation Mission to Israel and elsewhere is subject to very careful, expert scrutiny by security officials. We will visit specified sites only once we have received that security clearance, and we will cancel any visits that the security officials tell us may pose a potential danger. We take these steps, and adhere firmly to them, to protect you. The same prudence is to be exercised by all mission participants. It is requested that you abide by all guidelines and instructions given to mission participants by UJA-Federation of New York s representative offices during your stay. When we warn against visiting certain areas that we have been advised could be dangerous, it is firmly required that you honor these directions; should you elect otherwise, you should recognize that your safety could be imperiled and that you may be exposed to greater risk. Further, if you request an itinerary change that extends beyond our carefully developed and monitored security guidelines and program capability, our Missions Department and/or our Israel Office will not accommodate said requests. Questions about this may be directed to UJA-Federation of New York s Missions Department. Notwithstanding the above, if on your own accord you elect to make unilateral arrangements for a mission itinerary component outside of our security guidelines and program capability, we will ask to be kept apprised so that our missions office team can maintain contact with you at all times while you are away. We will use the training, good judgment, and experience of our overseas colleagues, overseas representative offices, and our entire Missions Department to seek to reward your expression of commitment to the people of Israel and elsewhere with a trip that is meaningful, fulfilling, and protective of your safety. These objectives will be accomplished if we have your trust and full cooperation in implementing this mission security protocol. 12. NOTICE OF RISKS OF TRAVEL TO ISRAEL AND ELSEWHERE, RELEASE, AND SIGNATURE I am aware of the risks of travel to Israel, including risks associated with my safety and security. I have read, or have had the opportunity to read, the United States Department of State s Travel Warning for Israel, Gaza, and the West Bank found at These risks include, but are not limited to, property damage and loss, death, or injury by accident, disease, or terrorist acts. I am voluntarily participating in the United Jewish Appeal Federation of Jewish Philanthropies of New York, Inc. ( UJA-Federation ) Mission ( Mission ) with a full understanding of these risks, and I assume and agree to accept all risks to my safety and security during the course of participating in the Mission. I acknowledge and affirm that, notwithstanding any security arrangements that may be made by UJA-Federation or any other party, UJA-Federation does not guarantee and is not responsible for my personal safety and my property while participating in the Mission or any Mission-related activities, including, but not limited to, airline travel, ground transportation, meals, lodging, and recreational activities, to include the activities of this particular Mission as described on the attached itinerary and/or in other materials distributed in connection with this Mission, including but not limited to, for example, cleanup and refurbishing of sites in Israel. In light of the above and in consideration of being permitted to participating in the Mission, I do, for myself, my spouse, my heirs, my executors, my administrators, and my assigns, release and forever discharge UJA-Federation and its respective subsidiaries, affiliates, predecessors, successors, and assigns, and all of its respective past, present, and future officers, directors, shareholders, employees, agents, and contactors, and their respective heirs, executors, administrators, and assigns (collectively, the Releasees ), of and from any and every claim arising from or by reason of any bodily injury, personal injuries known or unknown (including emotional trauma), death, or property damage resulting or alleged to result from any accident, or other episode that may occur, whether based on the negligence of, or the breach of contract by, any Releasee or any other party for whose acts may be responsible in law or in fact, or any other cause or principle of law, as a result of my participation in the Mission or any activities in connection with the Mission. 4
5 This release contains the entire agreement between the parties to this release. This release supersedes any prior or contemporaneous agreements, understandings, and negotiations regarding its subject matter. This release shall be interpreted and enforced in accordance with the laws of the State of New York, and shall be as broad and inclusive as permitted by such laws. If any provisions of this release are held invalid, it is agreed that the balance shall notwithstanding continue in full force and legal effect. I have carefully read the foregoing release and understand its contents, and acknowledge that this is a release of liability and, as such, is a binding and fully enforceable contract between me and UJA-Federation. 13. CANCELLATION PENALTIES (all penalties are per person) UJA-Federation has paid non-refundable deposits for the hotel rooms; therefore, the $1000 deposit is non-refundable. If the participant(s) cancels within 30 days of receipt of the application, and before Friday, September 8, 2017, any payments, other than the $1000 deposit, will be refunded. After that, there is no refund. There may be additional fees equal to the actual costs, including monetary penalties assessed and charged to UJA-Federation by the airlines and/or hotels and/or land operators. UJA- Federation does not assume responsibility for any penalties assessed by the airlines due to changes and/or cancellations of the flights or the mission. If you depart from the trip en route, UJA-Federation will not refund the cost of any unused transportation, hotel reservations, sightseeing, meals or any other tour services. We strongly suggest you purchase travel and trip cancellation insurance. 14. DISCLAIMER: UJA-Federation does not promote or endorse any company participating in this Tech Mission and takes no position regarding any risks that may be associated with participation or investment with any of the participating companies or with any overall investment strategy. Mission participants should not construe UJA-Federation as having reviewed or endorsed any of the information compiled and communicated as part of the Tech Mission by any company, presenter or other participant, and UJA- Federation does not represent that any such information is accurate or complete. Any person considering participation or investment in any company should consult with his or her legal and investment advisors and conduct a thorough due diligence process prior to making a decision. By participating in the Tech Mission, any financial/economic industry companies agree to comply with any and all applicable local and foreign securities laws and any other applicable laws and regulations. 15. SIGNATURE(S) OF ALL ADULTS NAMED ON THIS APPLICATION Print (s) Signature(s) Date UJA-Federation of New York reserves the right to limit participation based on eligibility requirements, space availability, and other criteria that it may determine in its sole discretion. In addition, UJA-Federation of New York reserves the right to terminate the participation of any mission participant whose behavior, in its sole discretion, is determined to be detrimental to the health, safety, or well-being of other participants and/or to the organization. Generally, under the Internal Revenue Code, any contribution that you make to UJA-Federation is deductible only to the extent that it, plus your payments for this mission, exceed the benefit received (in other words, the fair market value of the mission). In addition, any payments for extra air and/or land costs are not tax-deductible. 5
6 YOU MUST SUBMIT A COPY OF THE SIGNATURE/PHOTO PAGE OF YOUR PASSPORT WITH THIS APPLICATION Submit this form by scan/ , mail, or fax: Scan/ zelinn@ujafedny.org Fax: Mail: Missions Department, 130 East 59 th Street, New York, NY For more information please contact: Hadar Weiss at weissh@ujafedny.org or East 59th Street, New York, NY The world s largest local philanthropy, UJA-Federation of New York cares for Jews everywhere and New Yorkers of all backgrounds, connects people to their Jewish communities, and responds to crises in New York, in Israel, and around the world. 6
UJA-FEDERATION OF NEW YORK MISSIONS APPLICATION
UJA-FEDERATION OF NEW YORK MISSIONS APPLICATION WOMEN S EXECUTIVE CIRCLE MISSION TO RUSSIA SUNDAY, APRIL 22 SUNDAY, APRIL 29, 2018 1. Please reserve space(s) for the mission. I am paying a deposit of $
More informationMalibu Jewish Center and Synagogue. with Rabbi Judith HaLevy & Cantor Marcelo Gindlin. $3,300 per person for land package based on double occupancy
with Rabbi Judith HaLevy & Cantor Marcelo Gindlin $3,300 per person for land package based on double occupancy Please note that cancellations may result in land and/or air penalties and vary with each
More informationPARTICIPANT 2 (exactly as on passport) Name: (Title/First/Middle/Last) Place of Birth: Address: (Street/City/State/Zip)
Please complete this form and send to: Elena Zamudio, the FIDF Mission Liaison, from Mosaic Tours 6345 Collins Ave Miami Beach, FL 33141 or elena@mosaic-tours.com or Fax: (305)865 6522 or Tel:(305)865
More informationPARTICIPANT 2 (exactly as on passport) Date of Birth: Name: (Title/First/Middle/Last) Place of Birth: Name as you would like it to appear on name tag:
Please complete this form and send to: Elena Zamudio, the FIDF Mission Liaison, from Mosaic Tours 6345 Collins Ave Miami Beach, Fl 33141 or elena@mosaic-tours.com or Fax: (305)865 6522 or Tel:(305)865
More informationPARTICIPANT 2 (exactly as on passport) Passport #*: Date of Issue: Home/Office #: Date of Expiration: Nationality**: Mobile #:
Please complete this form and send to: Elena Zamudio, the FIDF Mission Liaison, from Mosaic Tours 6345 Collins Ave Miami Beach, Fl 33141 or Elena@mosaic tours.com or Fax: (305)865 6522 or Tel:(305)865
More informationTheir job is to look after Israel. Ours is to look after them. 1
Please complete this registration form and send to: Elena Zamudio, the FIDF Delegation Liaison, from Mosaic Tours 6345 Collins Ave Miami Beach, Fl 33141 or Elena@mosaic tours.com or Fax: (305)865 6522
More informationHadassah Mission Registration Form
Hadassah Mission Registration Form Kindly complete one registration form for each person traveling. Please refer to www.ayelet.com/hadassah.html for more information on particular Missions: Name of Mission:
More informationFirst Middle Last. Passport # Date Issued Expiration Date Place Issued. Nationality Date of Birth / / Birthplace Mo Day Year Mailing Address
CAARI Program 2018 APPLICATION INFORMATION REGISTRATION FORM PART 1 PRINT NAMES AS THEY APPEAR ON YOUR PASSPORT It is required that your passport be valid for at least six (6) months from your return date.
More informationFACULTY-LED STUDY ABROAD PROGRAM APPLICATION
FACULTY-LED STUDY ABROAD PROGRAM APPLICATION Country of Study: Dates of Travel: I. PARTICIPANT INFORMATION Name: Street Address: City: State: Zip Code: Date of Birth: Passport #: Country of Citizenship:
More informationCAARI Program 2010 Canadian American Active Retirees in Israel
CAARI Program 2010 Canadian American Active Retirees in Israel APPLICATION FORM PRINT NAMES AS THEY APPEAR ON YOUR PASSPORT It is required that your passport be valid for at least six (6) months from your
More informationOVERSEAS PROGRAMS STUDENT AGREEMENT
OVERSEAS PROGRAMS STUDENT AGREEMENT I, (print or type name of Student), acknowledge that I have voluntarily applied to an overseas study program ( Program ) offered by the Santa Monica Community College
More informationCAARI Program REGISTRATION FORM
CAARI Program 2019 - REGISTRATION FORM PART 1 PRINT NAMES AS THEY APPEAR ON YOUR PASSPORT It is required that your passport be valid for at least six (6) months prior to your return date. PARTICIPANT I
More informationTravel to Scotland Registration Form
Travel to Scotland Registration Form September 21 September 28, 2019 Please download and complete all six pages of this registration form and agreement and retain a copy for your records. One form for
More informationTravel to Iceland Registration Form
Travel to Iceland Registration Form June 24 June 29, 2019 Please complete all six pages of this registration form and agreement and retain a copy for your records. One form for each individual passenger
More informationBe A Paleontologist For A Week!
Be A Paleontologist For A Week! Join Science Center staff as we trek to eastern Montana to experience life as a paleontologist! During the week you will prospect for fossils of both dinosaurs and other
More informationTen Thousand Waves Tours LLC 2019 REGISTRATION
Ten Thousand Waves Tours LLC 2019 REGISTRATION MOUNTAINS & MONKEYS TOUR October 18 November 4, 2019 747,000 KYOTO, KYUSHU & THE KUMANO KODO November 7-25, 2019 848,000 TOKYO TIME extension between the
More informationPeople-to-People Travel with the Center for Cuban Studies
People-to-People Travel with the Center for Cuban Studies In addition to this application, please send us a copy of your passport information page. Please list the Name and Dates of Program you wish to
More informationIsrael - Off The Beaten Path with Petra Extension (optional)
Israel - Off The Beaten Path with Petra Extension (optional) Israel - NOV 12-20 / Petra - Nov 20-24, 2017 Thus says the LORD: Stand by the roads, and look, and ask for the ancient paths, where the good
More informationTravelearn Participant Form
Travelearn Participant Form Travelearn Program Faculty Coordinator Name Dates of Program This form must be completed in full, and must be accompanied by the following documents: $150 Administrative Fee
More informationTravel to Jordan Registration Form
Travel to Jordan Registration Form April 15 25, 2019 Please complete all six pages of this registration form and agreement and retain a copy for your records. One form for each individual passenger is
More informationStudy Abroad Agreement/Liability Release Form
Study Abroad Agreement/Liability Release Form Your Name (Last, First, Middle) Program Location Abroad Primary SUNY Campus For participants in Tompkins Cortland Community College Administered Overseas and
More informationPlease print and submit your study abroad application and deposit to the FVCC Business Office in Blake Hall.
2018 Conservation Ecology in Ecuador/ Galapagos Islands Deposit Form Please print and submit your study abroad application and deposit to the FVCC Business Office in Blake Hall. Upon receipt of your deposit
More informationASLD & BMOCA DO MOROCCO 2019
ASLD & BMOCA DO MOROCCO 2019 Join the Art Students League of Denver and BMOCA for a unique trip to Marrakech, Morocco Explore Morocco s Jewel of the South as we visit galleries, meet artists, and experience
More informationNUZ TRAVEL, LLC. Travel Application
NUZ TRAVEL, LLC Travel Application Name: (as printed on passport) Passport Number: Place of Issue: Date of Birth: Address: Interests (museums, history, nightlife, outdoor adventures, etc.): Passport Expiration
More informationTRIP COMMITMENT FORM India March 17 31, Emergency Contact Information $1,183 YES / NO
TRIP COMMITMENT FORM India March 17 31, 2019 Contact Information First Name: Last Name: Name As It Appears On Passport: Passport Information Number: D.O.B: Issued: Expires: Street Address: City, State,
More informationSTUDY ABROAD APPLICATION AND DEPOSIT
Please print, sign, staple and submit your study abroad application and deposit to the FVCC Business Office in Blake Hall. Upon receipt of your deposit and study abroad application, FVCC will contact you
More informationCHALLENGER WORLD TOURS (CWT)
CHALLENGER WORLD TOURS (CWT) TRAVELER REGISTRATION DOCUMENT & TERMS AND CONDITIONS Mail, Fax or Scan/Email To: Challenger World Tours Attn: Gareth Hughes 8263 Flint, Lenexa, KS 66214 USA Phone: 800-878-2167
More informationUS Civil Rights: On the Road to Freedom September 30 October 7, 2018
US Civil Rights: On the Road to Freedom September 30 October 7, 2018 Registration Form Please include with this completed registration, a signed signature page of the terms and conditions, a legible photocopy
More informationOriginal Impulse P.O. Box Denver, CO 80203
Capture the Wow Registration Form September 7-12, 2017 Welcome to Capture the Paris Wow! I look forward to this creative adventure with you in Paris. In order to secure your place in the retreat, please
More informationBeadventures Conditions, Responsibilities & Registration Form
Beadventures Conditions, Responsibilities & Registration Form Please review the following conditions and responsibilities associated with travel on a Beadventure before registering for a trip with Beadventures.
More informationIvy Tech Community College
Ivy Tech Community College POLICY TITLE International Travel for Faculty/Staff POLICY NUMBER ASOM 7.15 PRIMARY RESPONSIBILITY Academic Affairs CREATION/REVISION/EFFECTIVE DATES Created July 2013/Effective
More informationBaseCamp International Centers
BaseCamp International Centers Participant Terms and Conditions 1 Responsibility BaseCamp International Centers acts only as an agent for the accommodation providers, organizations and transportation companies
More informationThese forms are for reference only and will be sent to you to sign electronically. TEAM AGREEMENT
These forms are for reference only and will be sent to you to sign electronically. TEAM AGREEMENT Our vision for global(x) trips is that they will be opportunities for people to pursue spiritual growth
More informationAMBASSADOR APPLICATION AND AGREEMENT
Page 1! of 5! AMBASSADOR APPLICATION AND AGREEMENT A Friendship Force Exchange offers an opportunity for people from different parts of the world to share their lives with each other in the spirit of friendship.
More informationFor Participants in State University of New York Administered Overseas Academic Activities
AGREEMENT AND RELEASE FOR STUDY ABROAD STATE UNIVERSITY OF NEW YORK Overseas Academic Programs For Participants in State University of New York Administered Overseas Academic Activities To the Student:
More informationJMJ PILGRIMS, CORP. Terms and Conditions
JMJ PILGRIMS, CORP. Terms and Conditions YOUR CONTRACT IS WITH JMJ PILGRIMS, CORP. The registration conditions, information and terms in this literature form the basis of our contract with you, the participant.
More information6. Waiver of Liability and Indemnification University Sponsored International Travel by Students
6. Please fill in the requested information as indicated in the GRAY areas. Print, sign, and submit the form to the International Travel Coordinator (ITC) no later than 7 weeks prior to trip departure.
More informationBrooklyn College Study-Abroad-in-China Programs Student Application
Please Check a Program: Summer/ Winter, Year, in Beijing-Xi an-nanjing-shanghai, etc, China PERSONAL INFORMATION Name: (as on passport): CUNY EMPLID: SS# Sex: Date of Birth (MM/DD/YYYY): / / City/State/Country
More informationStudy Abroad Participant Agreement Assumption of Risk, Waiver of Liability and Indemnification
Standard Form Approved by the Lone Star College System Office of General Counsel Study Abroad Participant Agreement Assumption of Risk, Waiver of Liability and Indemnification I, (name of student) have
More informationINTERNATIONAL TRAVEL PROGRAM
1973 Edison Drive Piqua, OH 45356 INTERNATIONAL TRAVEL PROGRAM Acceptance, Release, Assumption of Risk and Waiver of Liability I, the undersigned ( Participant ), have been approved to participate in a
More information2016 OUCI Chinese Bridge Summer Camp Application
STUDENT INFORMATION Name (as it appears on your passport) Passport # Passport Expiration Date DOB Gender Cell Phone Email Address City State Zip PARENT/GUARDIAN INFORMATION Parent Phone Email Parent Phone
More information-WPI Off-Campus Study Travel Information Form Academic Year
-WPI Off-Campus Study Travel Information Form 2006-2007 Academic Year All students intending to complete a project at a WPI project site are asked to provide the IGSD with information about their travel
More informationSTATE UNIVERSITY OF NEW YORK Overseas Academic Programs AGREEMENT AND RELEASE FOR STUDY ABROAD
STATE UNIVERSITY OF NEW YORK Overseas Academic Programs AGREEMENT AND RELEASE FOR STUDY ABROAD For Participants in State University of New York Administered Overseas Academic Activities To the Student:
More informationSHORT-TERM MISSIONS APPLICATION
GENERAL INFORMATION Date Last Name First Name Middle Name Please print your name clearly EXACTLY AS IT APPEARS ON YOUR PASSPORT Present address: City State Zip DOB / / Age Gender: M F Grade Email Home
More informationAGREEMENT TO TERMS AND CONDITIONS OF CPCC EDUCATION ABROAD AND WORK-RELATED TRAVEL PROGRAMS
Please initial each page. 1 AGREEMENT TO TERMS AND CONDITIONS OF CPCC EDUCATION ABROAD AND WORK-RELATED TRAVEL PROGRAMS I, (print your name), in consideration of Central Piedmont Community College ( CPCC
More informationSouth Africa: Beyond Apartheid September 22 October 3, 2018
South Africa: Beyond Apartheid September 22 October 3, 2018 Registration Form Please include with this completed registration: 1. A copy of the photo page of your passport (first page only); 2. the signed
More informationVISA APPLICATION FORM
Marazul C harters Inc. Tel (201) 319-1054 Outside NJ 800-223-5334 (toll-free) F ax (201) 319-8970 Email info@marazul.com VISA APPLICATION FORM Professionals Abroad Delegation to Cuba ASEE: AMERICAN SOCIETY
More informationSavannah Tours Ltd (STL) Booking Terms and Conditions
P. O. Box 20517, Dar es Salaam.Tel 022.2120269 / 022.2139277; Fax : 022.2121812 E-Mail : info@savannahtz.com Web-site : www.savannahtz.com Tanzania Savannah Tours Ltd (STL) Booking Terms and Conditions
More informationAsheville-Buncombe Technical Community College Study Abroad Program Application
Asheville-Buncombe Technical Community College Study Abroad Program Application Application instructions Please read these instructions completely. ELIGIBILITY A-B Tech Study Abroad programs are for current
More informationEco Cuba Network People to People Cuba Trip APPLICATION FORM. Social Welfare in Cuba, April 28 May 6, 2018
Marazul Charters Inc. 1 Marine Plaza, Suite 302 North Bergen, NJ, 07047 Page 1 Tel (201) 319-1054 Outside NJ 800-223-5334 (toll-free) of 5 Fax (201) 319-8970 Email info@marazul.com www.marazul.com 1/16/2015
More informationUCLA GRAD TRIP JUNE 27 - JULY 9, 2018
UCLA GRAD TRIP JUNE 27 - JULY 9, 2018 WHAT'S INCLUDED 12 nights hotel accommodation, twin-share or triple share 16 meals: 11 continental breakfasts, 5 dinners Modern, air-conditioned coach with charging
More informationGovernors State University, College of Arts and Sciences Summer 2018 STEAM Camp Registration
Governors State University, College of Arts and Sciences Summer 2018 STEAM Camp Registration This is the registration form for the 2018 STEAM Camps at Governors State University. You may register by filling
More informationVietnam: Breathtaking Beauty and Indomitable Spirit March 3 15, 2018
Vietnam: Breathtaking Beauty and Indomitable Spirit March 3 15, 2018 Registration Form Please include with this completed registration, a copy of your passport (first page only), signed signature page
More informationASSUMPTION COLLEGE SUMMER Rome Program APPLICATION
ASSUMPTION COLLEGE SUMMER Rome Program APPLICATION APPLICATION CHECKLIST Applications will be considered complete when the following documents have been submitted: This application completed and signed
More informationSHSU International Travel Handbook Office of International Programs
SHSU International Travel Handbook Office of International Programs Updated 11/12/18 1 SHSU International Travel Handbook Table of Contents I. Travel Policies a. Texas State University System Policy-Foreign
More informationHoly Land Christian Ecumenical Foundation. With First Presbyterian Church of Boulder. April 27 May 8, days/ 11 nights REGISTRATION FORM
To reserve your space on this unique pilgrimage, complete the form below, scan and email it to the Pilgrimage Department at pilgrimage@hcef.org. NAME(S) as they appear on passport Address Roommate (if
More informationCOLLEGE OF CHARLESTON STUDENT CONSENT, MEDICAL AUTHORIZATION, AND RELEASE AGREEMENT (International Travel) Name of Program:
COLLEGE OF CHARLESTON STUDENT CONSENT, MEDICAL AUTHORIZATION, AND RELEASE AGREEMENT (International Travel) Name of Program: THIS FORM MUST BE SIGNED AND RECEIVED BY THE CENTER FOR INTERNATIONAL EDUCATION
More informationInside Iran September 5 17, 2018
Inside Iran September 5 17, 2018 Registration Form Please include with this completed registration, a clear color copy of your passport (first page only), signed signature page of the terms and conditions,
More informationInstructions: 2. a copy of passport. 3. a completed "Project Abroad" form. 4. a completed "Assumption of Risk and Release" form
Instructions: The following documentation needs to be submitted to the International Programs Office (Liberal Arts Building, Room 016) for approval of international travel supported by the University:
More informationUniversity Policies
University Policies www.fhsu.edu/policies/ POLICY TITLE: FHSU Policy for Educational Travel POLICY PURPOSE: This policy applies to any travel requiring at least one overnight stay away from campus, the
More informationNew York, August 2017 MODEL UN-UNESCO
MODEL UN-UNESCO EDUCATION AND UNITED AMBASSADORS MUN YOUTH ASSEMBLY New York, 18-25 August 2017 UN Security Council and Peace Education 18-20 August,2017 World Bank and Economic Education 21 August 2017
More informationSTATE UNIVERSITY OF NEW YORK Overseas Residency Electives Program Stony Brook University Hospital (SBUH) AGREEMENT AND RELEASE FOR STUDY ABROAD
STATE UNIVERSITY OF NEW YORK Overseas Residency Electives Program Stony Brook University Hospital (SBUH) AGREEMENT AND RELEASE FOR STUDY ABROAD For Participants in State University of New York Administered
More informationLofoten Islands Photo Tours
Leif Petersen Photography Lofoten Islands Photo Tours Registration Form First & Last Name (as shown on passport) Birth Date - D/M/Y (for hurtigruten booking) Street Address City, Province Postal Code Home
More information2015 ULTIMATE ICELAND REGISTRATION FORM(2 pages) Jack Graham Photography Workshops
2015 ULTIMATE ICELAND REGISTRATION FORM(2 pages) Jack Graham Photography Workshops WORKSHOP DATE REQUIRED INFORMATION Name Home Phone Cell Phone Address Emergency Contact Email Website/blog Age Please
More informationCorazon de Esperanza Service, Vision and Mission Trips ENROLLMENT CONDITIONS General terms and conditions
1 Corazon de Esperanza Service, Vision and Mission Trips ENROLLMENT CONDITIONS General terms and conditions These Enrollment Conditions are valid for all Corazon de Esperanza (CdE) trips departing after
More informationCapture the Paris Wow May 31st - June 5th, 2018
Capture the Wow Registration Form May 31st - June 5th, 2018 Welcome to Capture the Paris Wow! I look forward to this creative adventure with you in Paris. Included in our adventure is the following (plus
More informationAmerican Baptist Churches of Pennsylvania and Delaware January 30 - February 6, 2019 (Wednesday Wednesday) Haiti Mission Trip
American Baptist Churches of Pennsylvania and Delaware January 30 - February 6, 2019 (Wednesday Wednesday) Haiti Mission Trip Part 1: Mission Trip Application: The total Cost is $1,175 $400 Deposit Due
More informationFASHION INSTITUTE OF TECHNOLOGY OFFICE OF INTERNATIONAL PROGRAMS AGREEMENT FOR ASSUMPTION OF RISK AND RELEASE FOR INTERNATIONAL STUDY
FASHION INSTITUTE OF TECHNOLOGY OFFICE OF INTERNATIONAL PROGRAMS AGREEMENT FOR ASSUMPTION OF RISK AND RELEASE FOR INTERNATIONAL STUDY Students accepted to participate in international academic activities
More informationSTUDY ABROAD WAIVER OF LIABILITY, INDEMINIFICATION, AND MEDICAL TREATMENT AUTHORIZATION AGREEMENT
STUDY ABROAD WAIVER OF LIABILITY, INDEMINIFICATION, AND MEDICAL TREATMENT AUTHORIZATION AGREEMENT I,, desire to participate voluntarily in the Study Abroad Program, West Texas A&M University, described
More informationCOLLEGE OF CHARLESTON LIABILITY RELEASE, EMERGENCY MEDICAL AUTHORIZATION AND AGREEMENT (Domestic Travel)
COLLEGE OF CHARLESTON LIABILITY RELEASE, EMERGENCY MEDICAL AUTHORIZATION AND AGREEMENT (Domestic Travel) 1. I, the undersigned student desire to participate in the following activity/trip ( Activity ),
More informationTRIP REGISTRATION FORM 25% PER PERSON INITIAL DEPOSIT* DUE UPON BOOKING *35% PER PERSON INITIAL DEPOSIT FOR CRUISES AND THE GALAPAGOS
976 Tee Court, Incline Village, NV 89451 Tel: (800) 670-6984 or (775) 832-5454 Fax: (775) 832-4454 www.mythsandmountains.com travel@mythsandmountains.com TRIP REGISTRATION FORM 25% PER PERSON INITIAL DEPOSIT*
More informationTerms and Conditions 2017
1 Terms and Conditions 2017 Please read this agreement thoroughly and carefully. The Terms and Conditions quoted here are in effect immediately upon the receipt of your tour or trek payment or deposit.
More informationHamilton and Friends Musical Theatre Camp
JULY 9-20 SUMMER of 18! (Ages 9-13) Registration Form: $375.00/wk Early Bird Rate (now - March 1) $400.00/wk Standard Rate (beginning March 2) Child s Name: Date of Birth: Age: School Grade in the Fall:
More informationGLOBAL EDUCATION CENTER. GLOBAL EXPEDITION CONTRACT ( - Summer ) APPLICANT INFORMATION. Male Female Yes No DATE OF BIRTH GENDER HIGH SCHOOL STUDENT?
GLOBAL EDUCATION CENTER GLOBAL EXPEDITION CONTRACT ( - Summer ) APPLICANT INFORMATION NAME AS IT APPEARS ON YOUR PASSPORT (Last, First, Middle Initial) STUDENT ID NO. ADDRESS (Number, Street, Apartment)
More informationTERMS and CONDITIONS
Jack Graham Photography Workshops, Fuji X Photo Workshops & Ultimate Photo Workshops REGISTRATION & ACKNOWLEDGE of RISK FORMS Including TERMS and CONDITIONS Jack s Website Jack s Blog Email: jack@jackgrahamphoto.com
More informationPERSONAL DETAILS Please Print Clearly
Dear Volunteers, Thank you for your interest in the Albania Playground Build. We are excited for the opportunity to work alongside you for the kids of Albania. The need there is tremendous so we appreciate
More informationRegistration Form Pilgrimage 2017
Registration Form Pilgrimage 2017 In the Footsteps of St Columban August 13, 2017 - September 3, 2017 DUBLIN LUXEUIL BREGENZ DISENTIS OLIVONE BOBBIO MILAN ROME (IRELAND) (FRANCE) (AUSTRIA) (SWITZERLAND)
More informationPitcher & Powell International Cuisines and Culture Application Form 2016
Pitcher & Powell International Cuisines and Culture Application Form 2016 In order to secure your place in the course, please follow the steps (1) through (5) below. Please use one registration form per
More information4. Currency Wonderment sells its Journeys in United States Dollars (USD).
All bookings are made with Wonderment. By booking a trip with Wonderment, Client is deemed to have agreed to these Terms and Conditions (which constitutes the entire agreement between Client and Wonderment)
More informationPassport: please check expiration date - now must be good for 6 months past return date.
REGISTRATION INFORMATION TOUR COST: $12,585 P/P DOUBLE OCCUPANCY 1. Registration: complete each line and sign. 2. Deposit: $700 per person. This is a cash price; we prefer personal checks, money order/cashier
More informationTOUR PRICING (Based on the following group sizes: MAIN TOUR - Group of 16; Gobekli Tepe Extension - Group of 10)
Andrea Mikana-Pinkham, Director 888 501-3853 (toll free in the US) or 928 284-1429 www.sacredsitesjourneys.com info@sacredsitesjourneys.com TURKEY: Ancient Temples & Sacred Sites of the Great Goddess September
More informationThe Changing Faces of Russia: St. Petersburg and Moscow June 9 June 20, 2017
The Changing Faces of Russia: St. Petersburg and Moscow June 9 June 20, 2017 Registration Form Please include with this completed registration, a copy of your passport (first page only), signed signature
More informationMadrid, Spain & Lisbon, Portugal Registration
Madrid, Spain & Lisbon, Portugal Registration october 8-14, 2018 1451 s. olive avenue, west palm beach, fl 33401 / www.norton.org recommended arrival in madrid, spain: sunday, october 7 recommended departure
More informationASSUMPTION COLLEGE ROME PROGRAM APPLICATION
ASSUMPTION COLLEGE ROME PROGRAM APPLICATION APPLICATION CHECKLIST Applications will be considered complete and ready for review when the following documents have been submitted by the deadline. Students
More informationCHOWDOWN VIETNAM TOUR RESERVATION- REGISTRATION FORM
CHOWDOWN VIETNAM TOUR RESERVATION- REGISTRATION FORM TOUR DATE: 18 MARCH - 6 APRIL 2016-3 COUNTRY TOUR NAME: ADDRESS: CITY: PROV/STATE: POSTAL/ZIP CODE: COUNTRY: HOME PHONE: CEL PHONE: COUNTRY CODE: EMAIL
More informationTravel Liability and Waiver Form
1 Travel Liability and Waiver Form Each client (except minor children) must fill out this form and return it to us according to instructions at the bottom. It contains very important information regarding
More informationU.S.-CUBA TRAVEL PARTICIPATION AGREEMENT
U.S.-CUBA TRAVEL PARTICIPATION AGREEMENT Gulfstream Air Charter, Inc. ( Gulfstream ) offers a wide variety of services for travel to, from, and within Cuba. This U.S.-Cuba Travel Participation Agreement
More informationEducational Travel Program Information and Conditions
Educational Travel Program Information and Conditions This is important information. Please read carefully. When you register for an educational travel program, please sign (see end of document) and return
More informationLOTUS Fitness Retreats, LLC. Surf, Yoga & Fitness Retreat Booking Terms and Conditions
LOTUS Fitness Retreats, LLC. Surf, Yoga & Fitness Retreat Booking Terms and Conditions Date of Trip: January 19 January 26, 2019 Place of Trip: San José & Pavones, Costa Rica Accommodations: Hotel Barceló
More informationSTUDENT STUDY ABROAD APPLICATION COVER SHEET. Please initial by each item showing completion/agreement to criteria:
Revised: 6/12/18 STUDENT STUDY ABROAD APPLICATION COVER SHEET Please indicate destination and semester of interest: Destination: Semester: Please initial by each item showing completion/agreement to criteria:
More informationConfirmation of Participation
Confirmation of Participation studyabroad@ausm.community 773.583.7728 ausm.community 3460 W. Lawrence Ave Chicago, IL 60625 By submitting the last page of this Confirmation of Participation form you agree
More informationForeign Travel Participation Agreement and Waiver of Liability
Foreign Travel Participation Agreement and Waiver of Liability In consideration of the undersigned participant s (the Participant ) participation in the [Name of School] (the School ) trip to [Trip Location]
More informationCENTENARY COLLEGE OF LOUISIANA GLOBAL ENGAGEMENT
CENTENARY COLLEGE OF LOUISIANA GLOBAL ENGAGEMENT Contract, Release of Liability, Waiver of Rights, Assumption of Risks and Indemnity Agreement For International Educational Travel Opportunities I, ( Participant
More informationBooking Conditions. Group Travel. Pricing. Itinerary Variations. Booking Procedures. Enrollment. Making Payments
Booking Conditions Group Travel Study Abroad Association will travel with a group of 10-30 travelers per trip. Groups are teamed up by age and trip focus. For every 10 participants,study Abroad Association
More informationSummer Intersession 2018 Faculty-Led Travel Program Buenos Aires, Argentina Travel Dates: July 15th August 7th, 2018
Part A: Application Checklist, Agreement, and Release Form Please submit the following materials in support of this application: 1. This Completed and Signed Application Checklist, Agreement, and Release
More informationCHICO STATE FACULTY-LED STUDY ABROAD PROGRAM TANZANIA, SUMMER 2016 PROGRAM APPLICATION
CHICO STATE FACULTY-LED STUDY ABROAD PROGRAM TANZANIA, SUMMER 2016 PROGRAM APPLICATION 530-898-6105 RCE@CSUCHICO.EDU RCE.CSUCHICO.EDU/PASSPORT/TANZANIA2016 PROGRAM APPLICATION IMPORTANT DATES: April 11,
More informationColumbia Association INTERNATIONAL EXCHANGE PROGRAM French Cuisine & Culture Exchange - October 12 21, 2012
Dear Applicant: Thank you for your interest in the Columbia Association s 2012 French Cuisine & Culture Exchange with Cergy-Pontoise, France. Please read the attached application carefully, complete the
More informationAgreement, Waiver, and Release of Liability
DEERFIELD ACADEMY Deerfield, Massachusetts 01342 Student Name: Spain: Mysticism in the Footsteps of Teresa of Avila (March 9-18, 2019) Agreement, Waiver, and Release of Liability PLEASE INITIAL THE BOTTOM
More informationARKANSAS STATE UNIVERSITY STUDY ABROAD PARTICIPANT AGREEMENT
ARKANSAS STATE UNIVERSITY STUDY ABROAD PARTICIPANT AGREEMENT I,, am a student at Arkansas State University and plan to participate in the program from until. In consideration of permission to participate
More informationTHE NATIONAL WWII MUSEUM TRAVEL PROGRAMS TERMS & CONDITIONS
THE NATIONAL WWII MUSEUM TRAVEL PROGRAMS TERMS & CONDITIONS Tour Fare Your tour fare covers arrangements and services including hotel accommodations, meals as per the itinerary, gratuities, ground transportation,
More information