Educational field courses for educators & students in Costa Rica, Galápagos and beyond!
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©Holbrook Travel, Inc. 2007 IMPORTANT LEGAL NOTICE: Holbrook Travel believes all information to be accurate at the time of publication. However, we reserve the right to make corrections.
GSA Program Registration Formn




Your Name:
Home Address:
City:
State:
Zip:
Email:
Home Phone: ()
Work Phone: ()
Course Name
 
Program for which you are registering:

I am a
 
I will room with

Often participants like to communicate with each other after the course. May we share your contact information with the others?
Name as it appears on passport:
Date of Birth:
Passport Number:
Issuing Country/
Nationality:
Emergency Contact:
Relationship:
Phone: Home ()
Phone: Work ()
Educators please complete this section
Name of Academic Institution:
Title/Subject/Grade:
Institution Address:
City:
State:
Zip:
Email:
Air Arrangements


(Please provide a copy of your flight itinerary to us as soon as possible.)
If you would like us to make your arrangements, please provide the following:
Departure Preferences:
City:
State:
Seat Pref.:
Frequent Flyer Number:
Continental:
Delta:
American:
Health Information
I have the following medical or physical conditions that may limit my activities:
I am on the following prescription medications:
Please list dietary or other personal needs:
Meals commonly consist of local foods. Every effort will be made to accommodate special needs/requests but cannot be guaranteed.
Discounts
GSA Member GSA Member #
 
I am signing up with in order to receive
the "Bring Your Colleague or Spouse” Discount.
(Please note, you may only use one discount.)
Payment Information
Please charge my credit card for the following:
*(will be charged 60 days prior to departure)
Please charge my:
Name as it appears on card:
Credit Card Number:
Expiration date:
Statement of Disclosure

Holbrook Travel, Inc. and/or its agents assume no responsibility, or liability in connection with, the service of any train, vessel, carriage, aircraft, motor or other conveyance, which may be used wholly or in part, in the performance of their duty to the passengers. Neither will they be responsible for any act, error, or omission, or for any injury, loss, accident, delay or irregularity which may be occasioned by reason of any defect in any vehicle, or through neglect or default of any company or person engaged in conveying the passenger; or for any hotel proprietor, or for any other person, engaged in carrying out the purpose for which tickets or coupons are issued. In the event it becomes necessary or advisable for the comfort or well being of the passengers, or for any reason whatsoever, to alter the itinerary or arrangements, such alterations may be made without penalty to the tour operators. Additional expenses, if any, shall be borne by the passengers. No special considerations are made for medical condition or physical handicaps. The passenger accepts full responsibility for evaluating his/her fitness for this expedition, and shall bear any additional expense should he/she be physically unable to participate in any or all portions. The right is reserved to withdraw any or all tours should conditions warrant, also declining to accept or retain any passenger as a member of the tour. In such instances, full or equitable amount will be refunded, but this amount shall not exceed the amount paid by the passengers. No refund can be made for any feature of the program not used by the passenger during operation of the tour. The sole responsibility of any airline used in these tours is limited to that set out in the passenger contract evidenced by the ticket. Airlines and other carriers are not responsible for any act, omission, or events; during the time passengers are not on board their planes or conveyances. Similar responsibility as noted above applies to all types of carriers, including car rental companies. The services of any IATA and ATC carrier may be used in connection with these tours. The passenger understands that if he/she books special low cost airfares with penalties, and cancels the reservation, he/she is responsible for any penalties incurred from the airline. All contracts for services provided by Holbrook Travel, inc., and its affiliates are entered into in the State of Florida and all parties to such contracts submit to the exclusive jurisdiction of the courts of the State of Florida.
Important Information

If you become ill or are injured, your local guide, supported by the Tour Operator staff will make every reasonable effort to find medical help. Therefore, it is important that you advise them of any problem when it first arises. Should you become seriously ill or unable to participate in the program for any reason, arrangements will be made to return you home as safely as circumstances allow. Individuals with disabilities are asked to declare and describe in advance their specific conditions or circumstances that require special accommodations or arrangements.
Waiver

I certify that I am over the age of 18 years old or that I am the legal guardian of the child
with the authority to execute this agreement on his/her behalf.

I intend to be fully bound to the maximum extent permissible under laws, having been informed that I /my child may be participating in the below activities. While I understand that Holbrook Travel Inc. has made every effort to secure a safe program, I do recognize the inherent risk of travel, including personal injury or death, as well as the risk of property damage or loss of property taken on this trip.

I certify that I have been advised to carry the elective travel insurance for myself/my child.

I agree to indemnify all stated parties in this document of any and all costs, including attorney's fees, should litigation, mediation or other proceedings occur as a result of participation in any of the following activities:Hiking, Whitewater Rafting, Swimming, Snorkeling, Diving, Game Safaris, Turtle Tagging, Horseback Riding, Vehicle Transportation, Boat Transportation, Air Transportation

I am aware that in the event of gross misbehavior, (inclusive of drinking, abusive behavior, and disruption to the group itinerary), the operator, sponsoring educator, or Holbrook Travel Inc. has the right to refuse service and may require the participant to return home at additional expense to the participant or parent/guardian. Consult with the sponsoring educator for the rules and regulations of the school or academic institution as well as for policies on disciplinary matters.
Terms and Conditions

Land cost includes: Accommodations and meals as specified in the itinerary (including hotel/restaurant taxes, as applicable,) all local transfers, tours and activities as described in the itinerary. Accommodations listed in the itinerary are subject to availability and those of similar or better quality may be substituted.

Land cost does not include: Items not specifically mentioned in the itinerary, airport departure taxes, passport and visa fees, insurance, alcoholic beverages, soft drinks, bottled water, laundry, telephone calls, cables or any other expense of a personal nature. Neither will it include any tips. In-flight meals not served or missed due to changes are not covered.

Reservations and Final Payment: A deposit of $200.00 per person is necessary to confirm a booking; this deposit is applied to the total cost of the trip. All final payments are due no later than 75 days prior to departure.
Cancellations and Refunds

Cancellations received 75 days or more prior to departure are refundable less a $100 per person processing fee. Cancellations received within 75 days of departure are non-refundable. All cancellations must be received in writing; however, they will be considered effective upon advisement of the cancellation. We strongly recommend that you purchase trip cancellation insurance.

I certify that the information I have provided on this form is correct, and I have read and understand all the above policies pertaining to the trip.

Pre/Post Trip Extension

Please let us know if you are interested in extending your trip either before your Professional Development Course or after and we will be happy to help make the arrangements.

Pre Departure:     

Post Departure:   

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