Participant Registration Form
~South African Photography Safari~
Aug. 24 – Sept. 2, 2013
Cost: $6,775 (includes airfare and full package)
Participant Information
First Name: _______________________
Last Name: ______________________________ MI: _____
Address: _________________________________________________________________
City: ________________________
State: _____
Phone (work): _________________
Zip: ____________
Phone (home): _________________ Phone (cell): ___________________
e-mail: _________________________________________
DOB: ___/___/_______
Gender: M F
Name as it appears on Passport: __________________________________________________
Are you UWSP Alumni, Faculty, or Staff?: ___________________
Roommate Request: ________________________________
Emergency Contact (someone not traveling with you): __________________________
Relationship: _____________________________________
Emergency Phone: _________________________________
T-shirt or Jersey size:
XS
S
M
L
XL
XXL
Registration closes
March 15th, 2013
Health Information
I am in good general physical health
I am willing to prepare my body for a somewhat physically challenging recreational trip
I have the following medical physical conditions that may limit my activities:
___________________________________________________________________
___________________________________________________________________
Please list any allergies you may have:
___________________________________________________________________
Dietary or other personal needs or restrictions:
___________________________________________________________________
*Every effort will be made to accommodate special needs/ requests but cannot be guaranteed.
How did you hear about this tour? Please circle one or write in source:
Article in local paper
Email from UWSP Adventure Tours
Facebook Ad
Faculty Message of the Day
Presentation
Web Search
Magazine Ad
Email from UWSP Alumni Association
Mailing from UWSP Adventure Tours
Word of Mouth or other: ______________________________________
Please see page 2
Please make check payable to: “UWSP Adventure Tours”
Send to: UWSP Continuing Ed.
2100 Main St., 032 Main Bldg.
Stevens Point, WI 54481
Terms and Conditions
Deposit and Payment: A $1,000 non-refundable deposit is required per person to confirm your registration.
The deposit will be applied towards the cost of your trip. All final payments are due no later than 45 days
prior to departure.
Finder’s Bonus: Receive $100 off your trip for each participant you recruit. If you recruit 3 people then you
get $300 off your trip, etc. The participants can be family, friends, co-workers, neighbors, etc.
Discounts: UWSP Alumni receive a $50 discount for each trip.
Cancellations and Refunds: Cancellation of trips must be made in writing up to 12 weeks prior to departure
and will be refunded in full less your $1,000 non-refundable deposit. Requests made within 12 weeks of and
prior to 45 days before departure will be refunded 50% of the tour price (including airfare if applicable).
Cancellations made within 45 days of departure will not be refunded.
Refunds for Missed Days: We are unable to grant refunds for any missed portions of your tour because of
missed or delayed flights. Additionally, no refund is guaranteed for any feature of the tour not used as a
result of weather, personal health or social disturbance.
Insurance: Travel insurance is recommended. Visit the website for more travel insurance resources.
If We Cancel A Trip: Adventure Tours reserves the right to cancel a trip for force majeure or any other
circumstances beyond our control. We also reserve the right to cancel any trip if registration is inadequate to
make the trip economically feasible for us to operate or for safety considerations that pose a risk to the
group. If this happens, we will refund your trip in full for land costs. If airfare is booked through Adventure
Tours we will work with our travel agency to the best of our ability to either refund or transfer your flight costs
but there is no guarantee either will happen. Adventure Tours is not responsible for additional expenses
incurred by you in preparing for the trip (e.g. non-refundable air tickets, visa fees, gear, or medical expenses).
I certify that the information I have provided on this form is accurate and correct. I have read and agree to the
above terms and conditions. Enclosed is my $1,000 deposit to reserve a space for me on the tour requested.
I understand that Adventure Tours may use of any trip photos or video of myself or my child (if signing for a
minor) for public relations and promotional purposes and if I don’t wish photo’s or video of myself or child be
used I will notify Adventure Tours in writing.
___________________________________________
Signature of Participant
_________________
Date
___________________________________________
_________________
Date
Signature of Guardian or Parent (if applicant is under 18 years of age)
For Office Use Only
____ Deposit ____ Confirmation Letter Sent ____ Passport Copy Received
Please make check payable to: “UWSP Adventure Tours”
Send to: UWSP Continuing Ed.
2100 Main St., 032 Main Bldg.
Stevens Point, WI 54481
___ Packet Sent