Participant Registration Form
- Costa Rica Adventure January 6-15, 2015
Cost: $2,579 (USD)
Single Supplement: $365 (USD)
Participant Information
First Name: _______________________ Last Name: ______________________________ MI: _____
Address: _________________________________________________________________
City: ________________________
State: _____ Zip: ____________
Phone (work): _________________ Phone (home): _________________ Phone (cell): ___________________
e-mail: _________________________________________
DOB: ___/___/_______ Gender: M F
Name, exactly as it appears on Passport: __________________________________________________
Are you a UWSP Alum or UWSP Student? If yes, please circle one: Alum
Roommate Request: _____________________
Student
or Single Supplement:
Emergency Contact (someone not traveling with): ________________________
Relationship: _____________________________________
Registration closes
Dec. 10th, 2014
Emergency Phone: _________________________________
T-Shirt Size: S
M
L
XL
XXL
Health Information
I am in good general physical health
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 UWSP Adventure Tours? Please circle one or write in source:
Article in local paper
Facebook Ad
Email from UWSP Adventure Tours
Faculty - Campus Announcements
Mailing from UWSP Adventure Tours
Presentation
UWSP Alumni Association
Student - Campus Announcements
Web Search
Word of Mouth
Magazine Ad
Program Manager
Or other: ________________________________________________________________________________
Please see page 2
Terms and Conditions
Deposit and Payment: A $300 non-refundable deposit is required to confirm your registration. The deposit is
applied towards the cost of your tour. 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 refer. If you refer 3 people then you get
$300 off your trip, etc. The participants can be family, friends, co-workers, etc.
Discounts: UWSP Alumni & UWSP Students receive a $50 discount for each trip.
Flight & Travel Arrangements: Each participant is responsible for purchasing and arranging his or her own
flights as stated in the itinerary (this arrangement is most effective since many participants use frequent flyer
miles or have more flight connections). However, if enough participants travel from the WI area, a group flight
(roundtrip) can be arranged and UWSP Adventure Tours would then transport the group via passenger van(s)
to the airport (most likely O’Hare International). This would require an additional fee (determined by size of
group). Or, you can travel alone, arrive early, or stay late if you’re not part of this group. Please contact the
tour leaders regarding coordinating your flights. The “About” page on our website has airfare tips too:
www.uwspadventuretours.com
Cancellations and Refunds: Cancellation of trip must be made in writing up to 16 weeks prior to departure
and will be refunded in full less your $300 non-refundable deposit. Requests made within 16 weeks of and
prior to 45 days before departure will be refunded 50% of tour payments (excluding $300 non-refundable
deposit). 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, earthquake, personal health, or social disturbance.
Insurance: UWSP does not provide travel insurance, medical, or emergency evacuation and thus you are 100%
responsible for these expenses. We strongly advise you purchase travel insurance as soon as possible because
some insurance providers only guarantee certain benefits within a short time after you made this tour deposit.
If We Cancel A Trip: UWSP Adventure Tours reserves the right to cancel this trip due to force majeure or any
other reasons beyond our control. We also reserve the right to cancel this trip in cases of inadequate numbers
of registrations or for safety concerns. If this happens, we will refund your trip in full for land costs. UWSP
Adventure Tours is not responsible for additional expenses incurred by you in preparing for the trip (e.g. nonrefundable air tickets, visa fees, gear, travel insurance, 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 non-refundable $300 deposit to reserve a space for me on this
trip. I understand that UWSP Adventure Tours may use any appropriate trip photos or video of myself or my
child (if signing for a minor) for public relations and promotional purposes only and if I don’t wish photo’s or
video of myself or child be used I will notify UWSP Adventure Tours in writing.
___________________________________________
Signature of Participant
_________________
Date
___________________________________________
_________________
Signature of Parent/Guardian (if applicant is under 18 years of age)
Date
Please make checks payable to: “UWSP Adventure Tours”
Send to: UWSP Continuing Ed., 2100 Main St., 032 Main Bldg., Stevens Point, WI 54481