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Florida State Licensed Seller of Travel # ST36254
APPLICATION FOR TRAVEL
A separate, completed application is required for each participant over 18 years of age
Name (exactly as on passport): ______________________________________Preferred Name: ___________________
Passport #:__________________Nationality _______________ Date of Birth: _________________________________
Date of Expiration (must be valid for 6 months after date of arrival): ________________________________________
Home Phone: (____) _________________ Work Phone: (
)
___ Mobile: (__) ___________________
Fax: (_____) ______________ E-mail: - ________________________________________________________________
Address: ________________________________________________City: _____________________________________
State/Province: ____________________________Country: _________________________Postal Code: _____________
Please list ALL medical conditions, including allergies: _____________________________________________________
Please list your dietary concerns: ______________________________________________________________________
EMERGENCY INFORMATION (WHILE TRAVELING)
Contact Name: __________________________________________Relationship: _______________________________
Home Phone: (____) ______________Work Phone: (____) _______________Mobile: (____) ____________________
INTERNATIONAL FLIGHT INFORMATION
Airline & Flight #:
______ Date
Depart from
____Arrival Time in Lima: ___________
Return Flight #: ___________ Date: ________ Depart from LIMA- Time_________________
Trip Insurance which covers all possible scenarios is strongly advised.
TRAVEL INSURANCE COMPANY___________________________ POLICY#____________________________
DECLINE TRAVEL INSURANCE WAIVER
I, _______________________________________ decline travel insurance coverage for and during this trip departing on
_______________. I am aware of the cancellation penalties associated with my trip as explained on the Release of Liability and
Terms and Conditions. By declining the suggested travel insurance I am assuming the financial responsibility of those nonrefundable
penalties should I have to cancel or interrupt my travel, as well as any additional expenses incurred and not included in the program.
Neither Ancient Summit Enterprises, Inc., or its affiliated agents, employees, or volunteers are liable for my penalties or my decision.
Signature: ______________________________________________ Date: ____________________
Printed Name_____________________________________
Please make copies for your records.
13833 Wellington Trace E4 Suite 452 – Wellington – Florida – 33414
Phone: 561.228.1729 - email: info@ancientsummit.com – fax: 888.505.6875
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Florida State Licensed Seller of Travel # ST36254
RELEASE OF LIABILITY AND ASSUMPTION OF ALL RISKS
I, ________________________________________________, acknowledge that I have voluntarily applied to participate in the trip
designated on this application. I am participating on the tour with knowledge that travel to foreign countries and/or the remote areas
visited by this trip involves risks and dangers including but not limited to: a risk of illness; injury or death which may be caused by
forces of nature; civil unrest; terrorism; road conditions; injuries inflicted by animals, insects, reptiles or plants; trails; hotels; vehicles,
boats or other means of conveyance which are not operated nor maintained to standards common in the United States; high altitude
accident; accident or illness without access to means of rapid evacuation or the availability of medical supplies; the lack of adequate
medical attention once provided; the negligence (but not willful or fraudulent) on the part of Ancient Summit Enterprises, Inc. or its
affiliated organizations or employees, or volunteers. I acknowledge that the enjoyment and excitement of foreign travel/adventure
travel is derived in part from the inherent risks incurred by travel and activity beyond the accepted safety of life at home or work and
that these inherent risks and the corresponding enjoyment and excitement contribute to the reason for my voluntary participation on
this trip. I HEREBY ACCEPT ANY AND ALL RISKS OF ILLNESS, INJURY, EMOTIONAL TRAUMA, OR DEATH AND VERIFY THIS STATEMENT BY
PLACING MY INITIALS HERE _______________
AS LAWFUL CONSIDERATION for being permitted by Ancient Summit, Inc., a Florida corporation to participate on such trips and
activities, I hereby agree that I, my heirs, legal representatives or any member of my family will not make a claim against or sue
Ancient Summit, Inc., Nina Fogelman or any of her affiliated agents, employees, or volunteers for bodily injury, death, emotional
trauma or property damage resulting from my participation on the tour. I therefore release and discharge Ancient Summit, Inc., Nina
Fogelman and her agents, employees, and volunteers from and against any and all liability arising from my participation in the tour
or expedition for any reason whatsoever. I HEREBY ACCEPT THE ABOVE PARAGRAPH AND VERIFY THIS STATEMENT BY PLACING MY
INITIALS HERE _______________
If any portion of this agreement is unenforceable, the remaining portions shall remain in full force and effect. Under no circumstances
shall Ancient Summit, Inc. be liable to any tour participant for more than the amounts set forth in the cancellation policy noted in the
Terms and Conditions of the trip applied for on this document. I waive any charge-back rights. In the event of dispute, requests for a
refund will be made using the procedures described under “Cancellation and Refunds” as stated in the Terms and Conditions for this
trip. I HEREBY ACCEPT THE ABOVE PARAGRAPH AND VERIFY THIS STATEMENT BY PLACING MY INITIALS HERE _______________
All applications are subject to acceptance by Ancient Summit, Inc. Upon acceptance of my application, this agreement shall be
deemed to have been entered into in West Palm Beach, Florida and shall be construed according to the laws of the State of Florida. In
the unlikely event a legal dispute should arise involving any subject matter whatsoever, I agree that the exclusive venue for any legal
action shall be West Palm Beach, Palm Beach County, Florida. I HEREBY ACCEPT THE ABOVE PARAGRAPH AND VERIFY THIS
STATEMENT BY PLACING MY INITIALS HERE _______________
I have carefully read and fully understand the contents of this agreement as well as all the conditions as stated under the heading
“Terms and Conditions” (see attached pages) including those conditions regarding responsibility borne by trip participants and
conditions regarding cancellation and refunds. I am aware that this is a release of liability and a legally binding, enforceable contract
between Ancient Summit Enterprises, Inc. and me and I sign it of my own free will.
EXECUTED THIS ___________________ DAY OF _______________________ 20__________________
SIGNATURE _________________________________________________________________________
PRINTED NAME AS SIGNED _____________________________________________________________
13833 Wellington Trace E4 Suite 452 – Wellington – Florida – 33414
Phone: 561.228.1729 - email: info@ancientsummit.com – fax: 888.505.6875
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Florida State Licensed Seller of Travel # ST36254
TERMS AND CONDITIONS – Name of Traveler _____________________________________________
Ancient Summit, Inc., a Florida corporation with its principle place of business in West Palm Beach, Florida, gives notice that services
provided in connection with these itineraries are rendered by suppliers who are not agents or employees of Ancient Summit
Enterprises, Inc. All of the accommodations, meals, tours, transportation, and/or related travel services made by Ancient Summit
Enterprises, Inc. are made solely as an agent for the individual participant. While every effort is made to make travel arrangements
with reputable suppliers, the participant expressly agrees that Ancient Summit Enterprises, Inc. shall not be liable for any delay,
mishap, inconvenience, expense, irregularity, bodily injury or death, damage to property, wrongful or intentional acts or default of
any company or individual engaged in providing these arranged services. Each passenger conveyance, tour company, hotel
accommodation, restaurant, etc. is subject to the laws of the state or country where the service is provided.
Ancient Summit, Inc. and its principles, guides and agents are not qualified first aid or medical care providers and can assume no
liability to provide first aid or medical care.
Ancient Summit, Inc. reserves the right to decline to accept or to retain and disqualify from the trip, or any portion of the trip, any
person whose conduct or physical health impedes trip operation or the rights, welfare or enjoyment of other trip members. A
refund for unused services will not be given under such circumstances.
Ancient Summit, Inc., its principals, guides, and agents are not responsible for any expenses arising from the delay or extension of a
tour due to weather, political disputes, sickness, failure of public transportation, flight changes or cancellation, missed connections
or any other cause beyond its control.
Ancient Summit, Inc. must make substantial payments to suppliers, including providers of land travel, far in advance of tour dates.
If the trip is cancelled due to forces beyond Ancient Summit Enterprises, Inc. control (e.g. Acts of God, war, strikes, etc.), Ancient
Summit, Inc. will promptly refund the portion of the trip cost not advanced to suppliers or recoverable from suppliers. Ancient
Summit Enterprises, Inc. will use its best efforts to recover advance payments as promptly as possible and refund the amount
recovered, if any. However, Ancient Summit Enterprises, Inc. does not guarantee recovery of any or all of the advance payments
made. Ancient Summit Enterprises, Inc.’s best efforts will not include the institution of any legal proceeding in foreign lands. Travel
Insurance is very highly recommended.
Ancient Summit, Inc and/or its representatives may take photos during the operation of any program and use them for promotional
purposes. By booking a program with Ancient Summit Enterprises, Inc, participants agree to allow their images to be used in such
photos. If you prefer that your images not be used, please notify us by writing “No Photos” with your initials
here_______________________
PARTICIPANT RESPONSIBILITIES
Participants are responsible to accept a program appropriate to their abilities and interests. Participants are responsible to be in
sufficient good health to undertake the trip. Participants are responsible for preparing for this trip by studying the itinerary and predeparture information sent by Ancient Summit, Inc. and for discussing this itinerary with their physician.
Participants are also responsible for bringing appropriate clothing, medicines, supplies and equipment as advised and agreed to.
SPECIAL NOTE: During your travel with Ancient Summit you will be invited to certain places that are either exclusive to Ancient
Summit and/or the private homes of our friends and family. We ask you to please respect this privacy and not share this information
with anyone not traveling with Ancient Summit. Please accept and initial here____________
13833 Wellington Trace E4 Suite 452 – Wellington – Florida – 33414
Phone: 561.228.1729 - email: info@ancientsummit.com – fax: 888.505.6875
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Florida State Licensed Seller of Travel # ST36254
TERMS AND CONDITIONS (Continued) NAME:______________________________________
PRICING
Careful planning has allowed Ancient Summit, Inc. to set the price it offers to you and everything reasonable will be done to
guarantee that price. However, unexpected cost increases may occur due to the fluctuating dollar which increases costs to Ancient
Summit from third parties. We will always do everything possible to preserve the price and will notify you as soon as we are aware
of the total price.
Not included in the price are: items not mentioned in the agreed plan, items of a personal nature such as gifts, souvenirs, laundry
services, beverages, toll calls, excess baggage, medical costs, the costs of hospitalization and evacuation from remote areas, travel
insurance and additional expenses arising from delays or extension of a trip due to weather, political dispute, sickness, failure of
transportation or other causes beyond Ancient Summit Enterprises, Inc.’s control, tips for guides, drivers, porters, and hotel staff
and, any optional excursions. Travel Insurance is very highly recommended.
PAYMENT
30% Deposit is due upon acceptance of program and signing Application Forms
Full balance is due 90 days prior to travel
All payments are to be made to ANCIENT SUMMIT, INC. by check, or credit card. 30% deposit is required to secure your program.
Please contact us for alternative payment options or Pay Here With Credit Card
TRAVELER CANCELLATION AND REFUND
Inca Trail permits are completely NON-REFUNDABLE.
Notice of cancellation must be sent in writing, by email or by fax to Ancient Summit Enterprises, Inc.
Refund amount is based on the amount of time between receipt of cancellation notice and travel commencement date.
DAYS PRIOR TO DEPARTURE
90 days or more prior to departure
45 – 89 days or more prior to departure
0 – 44 days prior to departure
REFUND AMOUNT
All payments made LESS
- Non Refundable US $400 Planning Fee
- Non-recoverable expenses paid on your behalf
All payments made LESS
- Non Refundable US $400 Planning Fee
- US $400 Administration Fee
- Non-recoverable expenses paid on your behalf
No refunds.
EXECUTED THIS _______DAY OF _______2011
SIGNATURE___________________________________________________
Printed Name_____________________________________________________________________________________
13833 Wellington Trace E4 Suite 452 – Wellington – Florida – 33414
Phone: 561.228.1729 - email: info@ancientsummit.com – fax: 888.505.6875