Norma Schafer, Oaxaca Cultural Navigator LLC
Note: Everyone who books with us must read online Registration Policies and Cancellation Information, and complete this form. One Form Per Participant, Please. PLEASE COPY FORM TO WORD DOCUMENT, PRINT IT, COMPLETE FORM, TAKE A PHOTO OF COMPLETED DOCUMENT AND EMAIL TO email@example.com
Arrival Date: Departure Date:
Your Name as on Passport:
Passport Number and Expiration Date:
Your cell phone number: Your email address:
Required: Trip Cancellation and Medical Emergency Evacuation Insurance of $50,000+ USD. Proof of Insurance must be sent by email 45 days before program start date
[ ] I have read the Registration, Cancellation Policies and Procedures and agree.
[ ] Any medical condition(s) and medications? If yes, please explain. Can you walk 6,000 – 10,000 steps a day unassisted at 5-7,000 feet altitude? If no, please explain.
Emergency Contact Name/Relationship/Phone:
[ ] Dietary restrictions, allergies and needs. If yes, please explain.
[ ] I am a single traveler and prefer a single room.
[ ] I will share a room and I am traveling with _______________ [ ] I will share a room. Please find me a roommate.
Waiver of Liability
I, the undersigned, release and hold harmless Norma Schafer, Oaxaca Cultural Navigator LLC and their agents, successors and assigns associated with this event from any and all actions, causes of action, claims or demands for damages, personal injuries and death, and property damage or loss arising out of my participation in any capacity in any activities directly or indirectly associated with the Norma Schafer, Oaxaca Cultural Navigator LLC Study Tour. This waiver is on behalf of myself, my heirs, my executors, administrators, and assigns. No promise or inducement which is not herein expressed has been made to me, and in executing this Release I do not rely upon any statement or representation made by an person or their agent. I further state that I carefully read the foregoing Release and know the contents thereof, and I have accepted the same as my own free act.
PLEASE COMPLETE THIS FORM, PRINT, TAKE A PHOTO OF THE COMPLETED DOCUMENT AND EMAIL TO firstname.lastname@example.org