Saturday-Monday MLK Weekend, January 14-16, 2012
|
|
- Alice Johnson
- 5 years ago
- Views:
Transcription
1 Saturday-Monday MLK Weekend, January 14-16, 2012 LEd by dr. donald PrOthErO Join Skeptics Society for a wonderful three-day ur of highlights of Mojave Desert and Las Vegas area. We will sp at hisric resred ghost wn of Calico and take several urs, visit Afn Gorge where Ice Age floods drained Lake Manix, collect 550 million year old trilobites, experience spectacular boulders of Red Rock Canyon, and conclude with a guided ur of Hoover Dam. The Hoover Dam urs are NOT RECOMMENDED for anyone who suffers from claustrophobia, or has a pacemaker or defibrillar. Tours are conducted in confined spaces and in a powerplant with generars emitting electromagnetic frequencies. Those who can not participate in ur may enjoy visir's center. Each night we will stay at Excalibur Hotel on Las Vegas Strip, where you can explore Sin City on your own. Tour price includes charter bus, all hotel accommodations, breakfast and lunch each day, guided ur narration and guidebook, all or admission fees, and a tax-deductible contribution Skeptics Society of $130. Seats are limited about 50 people on a single ur bus, so ur should fill up fast. SATURDAY-MONDAY MLK WEEKEND, JANUARY 14-16, 2012 REGISTRATION FORM name address city state zip phone Please mark number of people participating in boxes below: To secure your place phone Skeptics Society office with a credit card number at Fill out and return registration, liability waiver and medical information forms complete your registration. n Skeptics Society members/single $685. each $ n Skeptics Society members/shared $585. each $ n nonmembers/single $785. each $ n nonmembers/shared $685. each $ GEOLOGY TOUR DISCOUNT SKEPTICS MEMBERSHIP RATE! Join Skeptics Society now & receive Skeptic magazine for only $25 and attend ur at member s rate. (U.S. residents only) $ CHECK # TOTAL PAYMENT $ Request LUNCH type n regular n vegetarian PRINT names of participants below exactly as you would like m appear on badges: Charge my: nmastercard n VISA n AmEx EXPIRATION DATE Month Year Account No. Signature as name appears on credit card VISA MasterCard * Roommates: The Skeptics Society is not responsible for finding roommates. We will let individuals know who else wants share a room, but if a suitable roommate is not found, you will be charged individual price. Cancellation policy: Before Dec.1: full refund. After Dec.1 thru Jan.1: $130 donation not refundable, refund of rest of fee. AfterJan.1: no refund. Liability and medical forms are required complete your registration. Download m as a pdf from skeptic.com/viva-mojave Contact us: Geology Tour, Skeptics Society, P.O. Box 338, Altadena, CA Fax: 626/ Or phone us at 626/
2 ITINERARY SATURDAY, JANUARY 14 7:45 a.m. Load Bus 8:00 a.m. Bus leaves from Paseo shopping center located at 280 East Boulevard in Pasadena, CA See attached map Meet on sidewalk on north side of building between N. Garfield Ave. and Eucild Ave. Parking is $9. per day. 10:30 a.m. Calico Ghost Town, Yermo, CA 12:00 p.m. Lunch 1:15p.m. Load Bus 1:30 p.m. Leave Calico Ghost Town 2:15 p.m. Afn Canyon Campground, Mojave Desert 2:45 p.m. Load Bus 3:00 p.m. Leave Afn Canyon Campground 5:00 p.m. Excalibur Hotel & Casino 3850 Las Vegas Boulevard South, Las Vegas, NV Excalibur.com SUNDAY, JANUARY 15 8:15 a.m. Load Bus 8:30 a.m. Leave Excalibur Hotel & Casino 9:00 a.m. Red Rock Canyon, Las Vegas 12:00 p.m. Lunch (Red Springs Group Picnic area) 1:15 p.m. Load Bus 1:30 p.m. Leave Red Rock Canyon, Las Vegas 2:30 p.m. Collect Trilobites (Immigrant Pass, Nopah Range) 3:30 p.m. Load Bus 3:45 p.m. Leave Immigrant Pass 5:00 p.m. Excalibur Hotel MONDAY, JANUARY 16 8:15 a.m. Load Bus 8:30 a.m. Leave Excalibur Hotel 9:20 a.m. Hoover Dam 11:15 a.m. Load Bus 11:30 a.m. Leave Hoover Dam 11:45 p.m. Lunch at Hemenway Valley Park 401 Ville Drive, Boulder City, NV 1:00 p.m. Load Bus 1:15 p.m. Leave Hemenway Valley Park 3:45 p.m. Break Lenwood exit, Barsw, CA 4:15 p.m. Load Bus 4:30 p.m. Leave Lenwood exit, Barsw, CA 6:00 p.m. Arrive at Paseo shopping center located at 280 East Boulevard in Pasadena, CA Contact Person: Teresa LeVelle, Mail : Skeptics Society Geology Tour, P.O. Box.338, Altadena, CA Fax: 626/ Phone: 626/ Pho by David Patn: Red Rock Canyon, Las Vegas.
3 SATURDAY-MONDAY JANUARY 14-16, 2012 SKEPTICS SOCIETY PARTICIPANT RELEASE AND WAIVER (All participants must complete this form for high-risk activity trips. i.e. hiking, rock climbing, desert/beach trips, etc.) 1. I AM AWARE OF THE RISKS OF CHOOSING TO PARTICIPATE IN THIS ACTIVITY. I ASSUME AND ACCEPT THE RESPONSIBILITY FOR THESE RISKS: I am aware that participating in geology ur on date listed above involves risks of personal injury, property damage and or associated risks. The activity has been explained me, including risks involved in participating in this activity, and I understand se risks. I voluntarily agree participate in this activity. I freely agree assume and take upon myself, full responsibility for any such risks of loss, property damage or personal injury, including death, that may be sustained by me as a result of participating in this activity wher caused by negligence of Skeptics Society or orwise. 2. I PROMISE NOT TO SUE THE SKEPTICS SOCIETY OR THE TRIP LEADERS DONALD PROTHERO AND TERESA LEV- ELLE FOR ANY INJURIES OCCURRING WHILE I AM PARTICIPATING IN THIS ACTIVITY: In consideration of Society s efforts in making this educational trip available and my being allowed participate, I hereby agree release, indemnify, hold harmless and forever discharge Skeptics Society, its direcrs, officers, employees, edirial/advisory board and agents, as well as trip leaders Donald Proro and Teresa LeVelle, from any and all claims and causes of action which might be brought by me or my parents or dependents on my behalf for loss of property, personal injury or death sustained by me arising out of any travel or activity conducted during period of my participation in above named activity. I understand that this release covers liability claims and actions caused entirely or in part by any acts or failures act of Skeptics Society (or its direcrs, officers, employees, edirial/advisory board and agents), Donald Proro or Teresa LeVelle including but not limited negligence, mistake or failure supervise by Society or ur leaders. 3. I WILL REIMBURSE THE SKEPTICS SOCIETY OR THE TRIP LEADERS DONALD PROTHERO AND TERESA LEVELLE FOR ANY COSTS IT INCURS DUE TO INJURY OR DAMAGE RESULTING FROM MY PARTICIPATION IN THIS ACTIVITY: I agree indemnify Skeptics Society, Donald Proro or Teresa LeVelle for any loss or costs, including medical bills, court costs and atrneys fees that it might incur due injury or damage resulting from my participation in this activity. 4. THIS AGREEMENT WILL ALSO PREVENT MY FAMILY FROM SUING THE SKEPTICS SOCIETY OR THE TRIP LEAD- ERS DONALD PROTHERO AND TERESA LEVELLE: It is my intent that this Agreement shall bind members of my family and spouse, if I am alive, and my heirs, assigns, and personal representative, if I am deceased. This Agreement shall be deemed as a release and consent not sue regarding any claims se parties may have against Skeptics Society or trip leaders Donald Proro and Teresa LeVelle relating my participation in this activity. 5. This Agreement shall be construed in accordance with laws of State of California. In signing this Agreement, I acknowledge that I have read it and understand it, I agree be legally bound by it and that I sign it voluntarily. IF PARTICIPANT IS UNDER EIGHTEEN (18) YEARS OF AGE, THE SIGNATURE OF A PARENT OR LEGAL GUARDIAN IS REQUIRED. Participant s Signature Date Printed Name Participant/Parent/Guardian Signature Date Printed Name Please return this completed form : Skeptics Society, P.O. Box 338. Altadena, CA YOUR TRIP REGISTRATION WILL NOT BE COMPLETED WITHOUT THIS FORM
4 SATURDAY-MONDAY JANUARY 14-16, 2012 SKEPTICS SOCIETY PARTICIPANT MEDICAL INFORMATION FORM (All participants must complete this form for high-risk activity trips. i.e. hiking, rock climbing, desert/beach trips, etc.) Participant s Name Birth Date Insurance Provider Insurance Telephone Insurance Address Date Docr s Name Docr s Telephone Contact Person (in case of emergency) Contact Person s Telephone Please return this completed form ALONG WITH A COPY OF YOUR INSURANCE CARD : Skeptics Society, P.O. Box 338. Altadena, CA YOUR TRIP REGISTRATION WILL NOT BE COMPLETED WITHOUT THIS FORM
5 134 Fair Oaks Union Corson o (one way ) Walnut Marengo N Garfield Euclid Westin Hotel You may park at Paseo Shopping Center at 280 East Pasadena, CA Parking is $9. per day. BUS WILL LOAD ON THE SIDEWALK IN FRONT OF THE PASEO COLORADO ON COLORADO BLVD., ( striped area between N. Garfield Ave. and. Euclid ) ENDS Green e Del Mar Arroyo Pkwy. PASEO COLORADO O Sheran Hotel Cordova Los Robles Oakland Madison Enter shopping center's underground parking area from Turn at Euclid drive down ramp and under building. Hiln Hotel p (A Starbucks is located on corner of shopping center at white "X".) 134 ENDS Fair Oaks Arroyo Pkwy. 110 Walnut Marengo Euclid PASEO COLORADOO Los Robles Oakland Madison Del Mar Madison Corson (one way ) Cordova ov El Molino Oak Knoll California n PASADENA ADE A Unionn Hudson Lake o Green Wilson Michigan Chester er Hollisn o Hill Caltech Campus Pasadena City College Allen o o.25.5 Miles Km.5 1.0
A DeAth VAlley ADVenture
January 16-18, 2010 A DeAth VAlley ADVenture Led by dr. donald Proro, this three-day trip will ur geologic wonders of natural hisry of great basin Join us for a 3-day, 2-night ur of beautiful scenery and
More informationPlease mark the number of people participating in the boxes below:
January 18-20, 2014 Led by dr. donald Prothero, this three-day trip will tour the geologic wonders of natural history of the great basin come join the skeptics society for an exciting trip to the geological
More informationPlease mark the number of people participating in the boxes below:
January 19-21, 2013 Death Valley ReDux Led by dr. donald Prothero, this three-day trip will tour the geologic wonders of natural history of the great basin come join the skeptics society for a fun three-day
More informationFire and ice in the Owens Valley
June 25-27, 2010 Fire and ice in Owens Valley Led by dr. donald Proro, this three-day trip will ur geologic wonders of owens VaLLey. come explore natural wonders of owens Valley-Mammoth Mountain area!
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 informationUndergraduate Student Organization Travel Application
Undergraduate Student Organization Travel Application 2011-2012 Organization Checklist: Application submitted at least 40 business days (8 weeks) prior to travel Proper Campus Advisor authorization Supporting
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 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 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 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 informationLilydale Fossil Hunt Friday, September 14, 2012
Lilydale Fossil Hunt Friday, September 14, 2012 Understand and experience this site in St. Paul from a solid scientific perspective, rather than an evolutionary theory perspective. Most of the time will
More informationField Trip Forms and Procedures
EAST SIDE UNION HIGH SCHOOL DISTRICT Instructional Services Division Julianna Arreola Administrative Secretary Phone: 347-5061 FAX: 347-5065 Email: arreolaj@esuhsd.org Field Trip Forms and Procedures Student
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 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 informationIf you plan to attend Campus Harvest, the cost is $ There is a non-refundable deposit of $55.00 that is due by Wednesday, February 25 th.
Dear Parents and Students, On the weekend of March 27-29, 2015 we are inviting all of our 10th - 12th graders to Raleigh, NC for the 25th annual Campus Harvest Conference with the theme, "Change the Campus,
More informationHELPING TEENS THRIVE. Youth & Government CENTRAL YMCA
HELPING TEENS THRIVE Youth & Government CENTRAL YMCA LEARN MORE WHAT IS YOUTH & GOVERNMENT? Learn first-hand how our state government works not by watching, but by doing! Each September for six months,
More informationMIAMI ROWING & WATERSPORTS CENTER, INC Membership (6 pages) Application For:
MIAMI ROWING & WATERSPORTS CENTER, INC. 2017 Membership (6 pages) Application For: FAMILY MEMBERSHIP: Initiation Fee: $500.00 Monthly Dues: $110.00 Annual Due $1320.00 Equipment Fund Monthly Due $15.00
More informationGENERAL RELEASE AND COVENANT NOT TO SUE THIS IS A GENERAL RELEASE AND WAIVER OF ALL LEGAL RIGHTS READ CAREFULLY AND UNDERSTAND FULLY BEFORE SIGNING
GENERAL RELEASE AND COVENANT NOT TO SUE THIS IS A GENERAL RELEASE AND WAIVER OF ALL LEGAL RIGHTS READ CAREFULLY AND UNDERSTAND FULLY BEFORE SIGNING Name of Participant: (print) Program and Destination:
More informationSTUDENT APPLICATION, CONSENT, MEDICAL AUTHORIZATION, AND RELEASE AGREEMENT (International Travel)
STUDENT APPLICATION, CONSENT, MEDICAL AUTHORIZATION, AND RELEASE AGREEMENT (International Travel) Name: Gender: CofC ID: If not a CofC student, please list name of home institution: Local Address: Street
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 informationTractor Safety Certification
Tractor Safety Certification June 15, 16, 17, 2015 Monday - Wednesday 8:00 am 3:00 pm Amity High School 503 Oak Street Amity, Oregon 97101 What: Tractor Safety Training and Certification Course, sponsored
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 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 informationPersonal Finance Summer Institute for College Readiness Application Instructions:
Personal Finance Summer Institute for College Readiness Application Instructions: Complete all fields in the Summer Institute Application (pages 2-6), print, and sign. Please print clearly or type. Make
More informationAdult 3-on-3 Basketball League 2018
Adult 3-on-3 Basketball League 2018 Welcome to s Adult 3-on-3 Basketball league. Seasons are either 8 or 10 weeks of play followed by play-offs (if you qualify). TEAM FEES/Per Season: $300 (8 Week Season)
More informationOctober 18, Listed below are the categories individuals can register for:
PANHANDLE DISTRICT 1 4-H October 18, 2013 The District 1 4-H Program is pleased to announce an opportunity for county 4-H programs to have volunteers certified as coaches in shotgun, rifle, or archery.
More informationTractor Safety Certification
Tractor Safety Certification June 16-18, 2014 Monday - Wednesday 8:00 am 3:00 pm Amity High School 503 Oak Street Amity, Oregon 97101 What: Tractor Safety Training and Certification Course, sponsored by
More informationVisions Global Empowerment and Nazareth College Ethiopia Service-Learning Trip (December 2018 January 2019) VOLUNTEER APPLICATION FORM
Visions Global Empowerment and Nazareth College Ethiopia Service-Learning Trip (December 2018 January 2019) VOLUNTEER APPLICATION FORM ALL VOLUNTEERS Permanent Address Information: NAME: STREET: CITY:
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 information2015 LBSC Ski Club Week Trip Aspen, Colorado
2015 LBSC Ski Club Week Trip Aspen, Colorado By Bob & Tara Shepard If you didn t see last month s July Ski Breeze, LBSC is going to Aspen, Colorado resort for their LBSC 2016 Week Ski Trip and will be
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 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 informationADULT 5-ON-5 BASKETBALL LEAGUE 2019
ADULT 5-ON-5 BASKETBALL LEAGUE 2019 Welcome to s Adult 5-on-5 Basketball league. Seasons are either 8 or 10 weeks of play followed by play-offs (if you qualify). TEAM REGISTRATION: Submit team roster and
More informationFACULTY STUDY ABROAD PACKET
FACULTY STUDY ABROAD PACKET This is the official application for the faculty sponsor in charge of a study abroad program at Northeastern State University. Please complete this application in full, including
More informationPersonal Finance Summer Institute Application Instructions: Read all instructions carefully, incomplete applications will not be considered.
Application Instructions: Read all instructions carefully, incomplete applications will not be considered. The 2017 will be June 26 June 30. Complete all fields in the Summer Institute Application. Print
More informationJAMZ 2017 HAYWARD SCHOOL CHEER & DANCE CAMP
JAMZ 07 HAYWARD SCHOOL CHEER & DANCE CAMP EVENT DETAILS WHEN: Tuesday, July th - Thursday, July 7th CAMP SCHEDULE: Coach Check-in: 9:00am (Tuesday) Camp Instruction: :00am - 9:00pm (Tuesday) 9:00am - 9:00pm
More information4-H SHOOTING SPORTS COACH CERTIFICATION TRAINING
TEXAS 4-H YOUTH DEVELOPMENT September 10, 2015 MEMORANDUM TO: FROM: SUBJECT: 4-H Shooting Sports Coach Candidates Laura A. Huebinger Extension Program Specialist 4-H Youth Development 4-H SHOOTING SPORTS
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 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 informationTRAVEL REQUEST FORM 1 (TR1) REQUEST FOR APPROVAL OF LSC SPONSORED STUDENT TRAVEL
TRAVEL REQUEST FORM 1 (TR1) REQUEST FOR APPROVAL OF LSC SPONSORED STUDENT TRAVEL Program Name: Destination: Name(s) of LSC Employee Traveling with Group: LSC Employee(s) phone contact: - - or - - Budget
More informationKids Creation Camp SCHOLARSHIPS ARE AVAILABLE! $205/Child $245/Child
Kids Creation Camp SCHOLARSHIPS ARE AVAILABLE! $205/Child $245/Child Kids Creation Camp SCHOLARSHIPS ARE AVAILABLE! $205/Child $245/Child Registration Form Please fill out and return to the address below
More informationTennessee Wesleyan University Volleyball Skills Camps
Tennessee Wesleyan University Volleyball Skills Camps s: June 2 and June 9, 2018 at James L. Robb Gymnasium (204 E College St, Athens, TN 37303) (1:00pm-6:00pm, check in begins at 12:30pm) Cost: $75 per
More informationNSU PREVIEW DAY. Wednesday, March 28, :00 a.m. 6:00 p.m.
PREVIEW DAY NSU Multimedia Camp Wednesday, March 28, 2018 8:00 a.m. 6:00 p.m. Parent/Guardian Contact Information Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement Photo Release
More informationINTERNSHIP APPLICATION
INTERNSHIP APPLICATION Personal / Academic Information: ID # Class Name First MI Last Major(s) CQPA MQPA E-mail Campus Box# Phone # Department of Internship Internship Title Start Date End Date Total Number
More informationBlue Zone Yoga. Paros, Greece Sept 30 Oct 7, 2018
Blue Zone Yoga Paros, Greece Sept 30 Oct 7, 2018 Trip Participant Agreement Terms and Conditions Name: Mobile: Home Phone: Address: City: State: Zip: E-mail: Emergency Contact: Relationship: Phone: Medical
More informationINFORMED LETTER OF CONSENT for EASM S MIDDLE SCHOOL RETREAT 02/23/ /24/2018
INFORMED LETTER OF CONSENT for EASM S MIDDLE SCHOOL RETREAT 02/23/2018 02/24/2018 Details of the activity: The Middle School retreat is an overnight event sponsored by Edgewater Alliance Church. Students
More informationSomervell County Horse Camp
25th Annual Somervell County Horse Camp June 3, 4 & 5, 2013 What is Horse Camp? This hands-on camp conducted by collegiate and professional horseman teaches functional horsemanship and improves horse training
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 information2019 Summer Band Camp
2019 Summer Band Camp The TEXAS A&M UNIVERSITY-KINGSVILLE SUMMER BAND CAMP provides high quality instruction to middle and high school students. The camp runs from Sunday, June 16 through Friday, June
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 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 informationTEXAS A&M INTERNATIONAL UNIVERSITY
AGREEMENT FOR WAIVER, INDEMNIFICATION, ASSUMPTION OF RISK AND MEDICAL TREATMENT AUTHORIZATION I,, age, desire to participate voluntarily in all activities of the ( Activity ), which is sponsored or conducted
More informationCity of Arcata Recreation Division 18th Annual Holiday Craft Market
City of Arcata Recreation Division 18th Annual Holiday Craft Market Dear Artists: Arcata Recreation s Annual Holiday Craft Market will be held on Saturday, December 9 th from 10am 5pm and Sunday, December
More informationContinuing Education 5.0 CEU hours available by application (additional $25 fee). Submit requests with your application below.
and Director of Public Affairs/Alumni Relations Connie Nelson Page 1 of 6 July 16 th (Departure from U.S.) to 27th, 2017 COST $1600.00 per person, twin sharing. Add $700 for a single room Does not include
More information2018 Summer Band Camps
2018 Summer Band Camps The TEXAS A&M UNIVERSITY-KINGSVILLE SUMMER BAND CAMP provides high quality instruction in the areas related to school band programs. Campers choose from one of three camp options:
More informationIndonesia. October Oct. 12th - Oct. 23rd. Includes: Pacific Wilderness, Inc. Diving & 2 Nights in Singapore!
Indonesia October 2017 $3,399 Includes Air, Diving & 2 Nights in Singapore! Join Us in October 2017 in beautiful Indonesia for another Dive Adventure! We ll dive North Sulawesi from the Tasik-Ria Resort
More informationTHIRD PARTY STUDY ABROAD PACKET
THIRD PARTY STUDY ABROAD PACKET This is the official application for enrollment into a study abroad program at Northeastern State University. You are currently not a student of NSU, thus no credit will
More informationCUNY OFF-CAMPUS STUDENT TRAVEL APPROVAL FORM New York City College of Technology
CUNY OFF-CAMPUS STUDENT TRAVEL APPROVAL FORM New York City College of Technology The Off-Campus Student Travel Approval Form must be completed by the Trip Sponsor and submitted to the Office of the Provost/VP,
More informationLake Washington Rowing Club
Lake Washington Rowing Club 2018 Junior Rowing Program Participant Information Form Participant Information (all fields must be filled out),, Last Name First Name Today s Date Mailing Address Birthdate
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 informationCamp Tatanka Summer Camp Registration Form
WTAMU and the City of Canyon Child s First Name Camp Tatanka Summer Camp Registration Form Camper & Parent s Information Last Name Grade Fall 2018: Age (on 1 st day of camp): Birth Date: / / M / F Child
More informationBest New Kart Tires for Fax:
www.decuzzitires.com Best New Kart Tires for 2010 330-220-3102 Fax: 330-220-3204 DECUZZI TIRE is the official tire for IKWC and PKE2010! DON T WAIT! Keep your club and track prosperous! Join the number
More informationLas Vegas, Nevada SOUTH POINT HOTEL & CASINO
TM V L AS E GA VE G L AS JULY 13-15, 2012 Las Vegas, Nevada SOUTH POINT HOTEL & CASINO Stay, Play and Race All in One Stop! Never leave the comfort of the Venue A SS nationals VENDORS: RIDER S PRO SHOP
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 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 informationCooke County 4-H Open Invitational Archery Tournament
Cooke County 4-H Open Invitational Archery Tournament When: November 15, 2014 Where: 2201 W. Highway 82 Gainesville, TX 76240 Registration Fee: $20 $30 (non-texas 4-H members) Registration Deadline: November
More information2017 Archer County 4-H White Tail Tune-up. 3-D & Field Archery Tournament. September 16, 2017
2017 Archer County 4-H White Tail Tune-up 3-D & Field Archery Tournament September 16, 2017 Where: Archer County Shooting Complex Archer City, TX 76351 (Please refer to map.) 8:00 AM Check-In & Equipment
More informationName - Mailing Address - Address - Occupation - Home Phone - Work Phone - Date of Birth - \ \ Name - Home Phone - Work Phone -
Please take time to carefully fill out this form as it will help us to plan your trip to your satisfaction. Name - Mailing Address - Email Address - Occupation - Home Phone - Work Phone - Date of Birth
More information2017 ISLANDER SOUND WAVES June 5-9, 2017
2017 ISLANDER SOUND WAVES June 5-9, 2017 The Texas A&M University-Corpus Christi Sound Waves for Singers offers high school students the opportunity to come to the "Island University" for a week of music
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 informationDMV Birthday Bash 12
DMV Birthday Bash 12 July 13 th - 20 st, 2019 NEGRIL, JAMAICA HEDONISM 2 Another Week of No Worries EVERYDAY WE LIT Send your nonrefundable $200 deposit Through Paypal to Dmvbirthdaybash2019@gmail.com
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 information2018 CYC Junior Rowing Summer Program Registration
2018 CYC Junior Rowing Summer Program Registration Rower s Last Name First Name Age/DOB Address City State Zip Code Email Cell School Grade Level (Fall 2018) Parent s Last Name First Name Address City
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 informationTexas Southern University Ocean Of Soul Marching Band. Summer Band, Auxiliaries, and Drum Major Camp Sunday, June 18 th to Saturday, June 24 th, 2017
Texas Southern University Ocean Of Soul Marching Band Summer Band, Auxiliaries, and Drum Major Camp Sunday, June 18 th to Saturday, June 24 th, 2017 Ocean of Soul Band Camp Registration Information All
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 informationJAMZ 2017 THOUSAND OAKS CHEER & DANCE CAMP
JAMZ 07 THOUSAND OAKS CHEER & DANCE CAMP EVENT DETAILS WHEN: Saturday, August th - Sunday, August th CAMP SCHEDULE: SATURDAY 8:0am - Coach Check-in 9:0am - :0pm - Camp Instruction SUNDAY 9:0am - :0pm -
More informationAlaska Airlines Cheer on the Dawgs in Atlanta Sweepstakes Affidavit of Eligibility, Liability & Publicity Release
Alaska Airlines Cheer on the Dawgs in Atlanta Sweepstakes Affidavit of Eligibility, Liability & Publicity Release STATE OF COUNTY OF Alaska Airlines, Inc. ( Sponsor ) is the sponsor of the Alaska Airlines
More informationAll Documents in this Packet MUST BE COMPLETED and Returned to the Group Leader along with your Trip Deposit in order to Reserve your Space.
DOCUMENT CHECK-LIST All Documents in this Packet MUST BE COMPLETED and Returned to the Group Leader along with your Trip Deposit in order to Reserve your Space. Please ask for a Copy of these Documents
More informationCSUB Field Trip Policy
CSUB Field Trip Policy Per the CSU Chancellor s Executive Order No. 715, the following constitutes the Field Trip Policy of California State University, Bakersfield (CSUB). For the purposes of this policy,
More informationTerms & Conditions. Page 3
a a rs i n R a n cho MAY 17 19, 2019 E x h i b i t o r B r o c h u r e 31 ST ANNUAL INSOLVENCY CONFERENCE WESTIN MISSION HILLS MAY 17-19, 2019 www.calbf.org M i ra ge Re ch fo St e h rt Exhibit Area Westin
More informationSTUDENT STUDY ABROAD PACKET
STUDENT STUDY ABROAD PACKET This is the official application for enrollment into a study abroad program at Northeastern State University. Most programs offer an elective credit that can be applied towards
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 informationRegistration Form. Special Information (allergies, medical, behavioral, etc) you would like us to know about the gymnast/dancer:
Registration Form Gymnast/Dancer Information Name: Date of Birth (MM/DD/YYYY): School (For Scheduling Purposes): School District (For Scheduling Purposes): Special Information (allergies, medical, behavioral,
More informationANTEATER RECREATION SUMMER CAMP
ANTEATER RECREATION SUMMER CAMP COMPLETING YOUR WAIVER FORMS All forms have the ability to be completed through Adobe Acrobat. At this time, the University still requires inked (not electronic) signatures.
More informationSPIRIT QUEST TOURS BOOKING TERMS & CONDITIONS
SPIRIT QUEST TOURS BOOKING TERMS & CONDITIONS Please note: Each guest needs to INITIAL AND SIGN this contract FAX to (877) 406-5206 OR scan and email to halle@spiritquesttours.com OR mail to the address
More informationA&M REC ROAD TRIP. August 28/29 Drop Off at 8:30pm at the Atrium of the Woodway Campus Pick up at 7:30 am or after Bible Study on Sunday morning.
A&M REC ROAD TRIP 7 th and 8 th Graders of 2010 Road Trip to the Student Recreation Center at Texas A&M University August 28/29 Drop Off at 8:30pm at the Atrium of the Woodway Campus Pick up at 7:30 am
More informationWelcome To The MasterDrive Experience. Driving Camp Application Package Instructions And Keys To Success
3280 East Woodmen Road, Suite 100 Colorado Springs, CO. 80920 719 260-0999 fax 719 260-9676 Visit our website at www.masterdrive.com Welcome To The MasterDrive Experience Driving Camp Application Package
More information2018 Youth Academy Parent/ Guardian Agreement with NUS s Continuing Education
2018 Youth Academy Parent/ Guardian Agreement with NUS s Continuing Education Welcome to NSU Youth Academy! We are excited to have your child with us. In order to provide the best experience for our students
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 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 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 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 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 informationPreliminary New York Choir and Band Trip Itinerary June 6-12, 2017
Day 1 June 6, 2017 Preliminary New York Choir and Band Trip Itinerary June 6-12, 2017 Load bus at Montevideo High School (approx. 5:00 am) Depart on trip! Band and choir clinics at a location on the way
More informationBubbaFest Florida Keys November 3th November 10th, 2018 Please TYPE or PRINT CLEARLY
BubbaFest Florida Keys November 3th November 10th, 2018 Please TYPE or PRINT CLEARLY Name: Male: Female Address: Age City, State & Zip: Home Number: Email Address: Cell Phone: Shirt Size Vegetarian meal
More informationArmstrong High School Kevin Martin Orchestra Director
Kevin_Martin@rdale.org 10635 36 th Ave. N Plymouth, MN 55441 763-504-8855 Armstrong High School Kevin Martin Orchestra Director Dear Orchestra Families, The 2015-2016 Armstrong High School Orchestras will
More informationIndividual Budget Request Form
Individual Budget Request Form Please complete this form outlining the request to be applied to your annual budget. Supporting documentation (i.e. hotel quotes, registration forms, travel costs, etc.)
More information50Plus Expo. (805)
The Pleasant Valley Recreation and Park District Senior Center invites you to participate in the 12th annual 50 Plus Expo on May 1, 2018 from 9:30am to 1pm, at the Community Center, 1605 E. Burnley St.,
More informationTOUR PRICING. NOTE: Sacred Sites Journeys tours are smoke-free. E-cigarettes are allowed.
Sacred Sites Journeys A Division of Heartlight Fellowship Andrea Mikana-Pinkham, Director PERU: Ancient Mysteries of Machu Picchu, Cusco & the Sacred Valley of the Incas June 4-13, 2017 Post-Tour Extension
More information