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Registration Form for Avignon, France

In order to secure your place on the trip, please read the instructions below and fill out

the form completely. Sign the form, and mail with payment to:

Elizabeth Trester, 9340 Beatties Ford Rd, Huntersville, NC 28078

Questions? Contact me at:

Elizabeth : 704-206-0844

Please provide your contact information

Name________________________________________________

Street Address__________________________________________

City State Zip__________________________________________

Phone Fax_____________________________________________

E-Mail_________________________________________________

Birthday Passport #_____________________________________

Allergies_______________________________________________

Special Dietary Needs____________________________________

Medications_____________________________________________

Smoking/Non___________________________________________!

Who To Contact In Case Of Emergency!

Name____________________________________________________

Phone___________________________________________________

Address__________________________________________________

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The tour begins on October 8, . On the 8th, all those

continuing on will join us to Paris, we depart on the 13th for Dublin and fly home.

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Elizabeth and Company    Registration Form for Avignon, France

We can’t wait to meet you, so tell us a little about yourself now.

What is one thing you would wish to gain from this adventure?

_____________________________________________________________________________

What attracted you toProvence?

__________________________________________________

What art forms will you be exploring while in Provence?

________________________________

Where did you hear about us?___________________________________________________

 

Carefully read our policies and registration form.

Prices include: accommodations in Provence ,tours, ground transportation with the

group. Airfare and transportation to and from the airport are not included. Prices subject to

change without notice, according to the fluctuations of the euro.

Cancellations and Refunds

A $1,000 per person non-refundable deposit is required to reserve a space on the trip. Balance is

due 60 days prior to the start of the tour,June 30 . For cancellations 61 days or more prior to

departure, fees paid are refunded less the $1000 deposit. Cancellations made 60 days or less prior

to departure will result in the loss of all monies received. Exceptions to this cancellation policy

cannot be made for any reason, including personal emergencies. There is no refund for leaving a

program early or arriving late. There are no refunds for any part of the program that you choose

to opt out of.

We reserve the right to cancel any program prior to its start, in which case all monies will be

refunded.

Itinerary

We have the right to make partial changes to the stated itinerary. We will do our best to keep

changes to a minimum.

Photo Release

We will photograph group activities for use in brochure/publicity. Please notify us if we are not

free to use photographs of you.

Waiver and Emergency Information

Please remember to include the signed waiver and emergency information with your deposit.

I have read and agree to the terms written above. (please sign)

Name and Date

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!Registration Form for Provence

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Waiver: Release and Assumption of Risk

I hereby acknowledge that I have voluntarily applied (the “Applicant”) to Elizabeth

and Company (the “Operator”) and that the Operator relies in part on others to

provide instruction, overnight accommodations, personal tours and transportation to

and from such tours. The Operator,

while exercising reasonable care in selecting such premises and independent

contractors, does not guarantee without limitation their suitability or performance. I

understand that no refunds will be given for any part of the tour that the Applicant

chooses to opt out of.

I further herein acknowledge and agree to release, absolve, indemnify and hold

harmless the Operator, its organizers, sponsors, shareholders, and employees from any

injury or loss caused by or resulting from the leased accommodations

or employment of any and all independent contractors (the “Agreement”), unless such

injury or loss resulted from the gross negligence of the Operator in selecting such

premises or employing such party(s). This agreement shall also serve as a release and

assumption of risk from my heirs, executors, administrators, and all members of my

family. I have carefully read this Agreement, understand that I am releasing certain

legal rights that I otherwise have and I enter into this Agreement freely and voluntarily.

I understand the Operator, in accepting my application to attend, does so based on this

representation.

IN WITNESS WHEREOF, this Release and Assumption of Risk is executed and

presented to the Operator on _________, 20___. By:

(Applicant)

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!Registration Form for Avignon

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Travel Insurance

We strongly recommend you purchase travel insurance. We do not provide travel

insurance. Please check one of the boxes below to indicate what your travel insurance

plans are.

____ Yes, I choose to purchase travel insurance. I will send you my details about my

travel insurance.

____ No, I decline to purchase travel insurance and I am assuming any financial loss

associated with my travel plans.

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Payment Method

Total Amount Due: $3400 is the total amount of this trip. A deposit of $1000 per

registrant is due by April 10-2014. Balance of $2400 due 60 days prior to trip or

Aug31,2014. Failure to submit payment by this date could result in loss of your space

on this trip. !

-Payment in Full- -Deposit- (please circle one)!

Payment with Check

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Amount $________________

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Return signed form and payment to:

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