Poland Prague Jewish Heritage Tour
July 10, 2016 - July 20, 2016
Enrollment Form
An enrollment form is required for each traveler and must be completed, signed and returned in order to
secure a place on this tour. An initial deposit of $300 per person is due with this application.
The Tour has two booking options: “Land only” or “Land and Air”. Airfare is economy seating. Once our tour
company, Tourico, has confirmed the group’s plane tickets with Lufthansa on March 13, 2016 you may
upgrade your economy seating directly with the airline.
Trip payment may be made via two options: One total payment by check or credit card (American Express,
MasterCard or Visa) at the time of enrollment OR separate credit card payments according to a predetermined
schedule outlined below. A 3% processing fee will be added to each credit card transaction.
Space is limited!
(Please print)
Your full name: (as it appears on your passport) ______________________________________________
Mailing address________________________________________________________________________
City _________________________________________ State ________ Zip ________________________
Cell phone _____________________________ Home phone ___________________________________
Email address: _________________________________________________________________________
Marital status: [ ] Married [ ] Single Sex: [ ] Female [ ] Male Birthdate: (M/D/Year)____________
Passport information:
Passport Number: _________________________________ Place of issue: ________________________
Issue date: _______________ Expiration date: ___________ Place of birth: ________________________
Emergency contact information:
Name: ______________________________________________ Relationship: ______________________
Address: _______________________________________Phone __________________ or_____________
Rates: Land only
Single $2,000
Double $1,500
Triple $1,200
Select Package: [ ] Land only
Land and Air (coach fare)
Single
$3748
Double
$3248
Triple
$2948
[ ] Land AND Air [ ] Individual Total $ _______
Payment method: [ ] Check [ ] Credit Card (single payment) [ ] Credit Card (payment schedule
below)
Room occupancy:
[ ] Single room
[ ] Double room (I will share a room with) __________________________________________________
[ ] Triple room (I will share a room with) 1._________________________2.________________________
Payment schedule (if paying by credit card):
[ ] $ ______ Initial deposit owed with enrollment form ($300 p/p)
[ ] $ ______ First payment, February 1, 2016 (50% of remaining balance)
[ ] $ ______ Second payment, March 1, 2016 (50% of remaining balance)
[ ] $ ______ Final payment, April 1, 2016
CREDIT CARD AUTHORIZATION*: I authorize the Holocaust Memorial Resource and Education Center of
Florida, Inc., to charge the listed credit card according to the payment schedule above.
_________________________________________________________________________________________________________________________________________________________________________
Name
Date
Billing name as it appears on the credit card/statement: _______________________________________
Billing address: ________________________________________________________________________
_______________________________________________________________________
Card type (circle): AMEX MC VISA
Card number: _________________________________________________________________________
Expiration date: __________________________ 3 or 4 Digit Security Code: _______________________
Cardholder’s signature: _________________________________________________________________
*A 3% processing fee will be added to each transaction.
Travel Insurance: Travel/Medical insurance is REQUIRED and proof of insurance must be presented to
the Holocaust Center no less than 30 days prior to the trip. Participants are responsible for acquiring
insurance. You may purchase insurance on your own, or arrangements have been made with Marjorie
at Take Me Along Travel, to provide assistance for the required insurance. Their phone number is 404262-3460.
The package includes the following:
 9 nights in 4-star accommodations
 Daily breakfast in the hotels
 10 days with a licensed tour guide
 10 days in a tourist class bus equipped with AC, TV and DVD
 Entrance fees to all sites listed per the itinerary
 Baggage handling fees for the hotels
 Taxes and fees
 Liability insurance of $5,000,000
 Pre-trip educational seminars at the Holocaust Center
The rates do not include:
 Mandatory travel/health insurance. (See above)
 Gratuities for bus driver and tour guide (suggested amount $40-$50 p/p).
 Lunches and dinners
 Shopping
 Any service that was not described above
Cancellation Fees and Change Policies*:
*All changes and cancellations MUST be made in writing and delivered by Certified Mail to the Holocaust
Memorial Resource and Education Center of Florida, Inc., 851 N. Maitland Avenue, Maitland, FL 32751.
Changes to reservations are subject to change fees. No refunds or exchanges will be made for any unused
packages. No compensations will be issued for lost, destroyed or stolen documents or tickets. Unused services are
non-refundable.
Cancellation charges, per person, are:
 Up to 120 days before departure (March 12, 2016): No penalty
 Up to 75 days before departure (April 26, 2016): $450
 Up to 45 days before departure (May 26, 2016): $600
 Less than 45 days before departure (May 27, 2016): Penalty charged is the full amount
General Terms and Conditions
REFUSAL OF SERVICE: Barring the exercise of any illegal discrimination, Tourico reserves the right to
otherwise refuse service and/or decline accepting or retaining any person as a member of any Tour at
any time. In such event, Tourico’s sole obligation shall be to refund the affected Tour member for any
unused accommodations or other paid Tour elements. Each Tour member shall be free of any known
mental, physical or other condition or disability that could create a hazard for himself/herself and/or
other Tour members.
TOUR MEMBERS NEEDING SPECIAL ASSISTANCE: Any disability requiring special attention should be
reported to the Holocaust Center at the time the reservation is made. The Holocaust Center and its tour
operator Tourico will make reasonable efforts to accommodate the special needs of disabled tour
members. However, neither the Holocaust Center nor Tourico are not responsible in the event it is
unable to do so, nor shall the Holocaust Center or Tourico be responsible for any denial of services by
carriers, hotels, restaurants, attractions or other independent suppliers. The Holocaust Center and
Tourico regret that it cannot provide individual assistance to a Tour member for walking, dining,
boarding/exiting motor coaches or other transportation vehicles, or other personal needs. Tour
members who need such assistance must be accompanied by a qualified companion.
THIRD-PARTY RESPONSIBILITY: The Holocaust Center, Tourico, its employees, shareholders, subsidiaries,
affiliates, officers, directors, successors and agents, do not own or operate any entity which is to, or
does, provide goods and/or services for Tours including, but not limited to, lodging facilities; motor
coaches, water vessels or other means of transportation; guides or guide services; local ground
operators; providers or organizers of optional excursions; food service providers, etc. All such persons
and entities are independent contractors. Consequently, neither the Holocaust Center nor Tourico are
liable for any negligent or willful act or failure to act by any such third-party entity or personnel thereof.
Force Majeure: Neither Party shall be liable for failure to perform its obligations under this Agreement if
such failure results from acts, events, omissions or happenings beyond its reasonable control including,
without limitation, natural disaster (including without limitation violent storms, floods, cyclones,
earthquakes, or destruction by lightening), fire, explosion, insurrection, war or other hostilities, riot, civil
commotion, embargo, the requirements or regulations of any civil or military authority, accident,
industrial dispute (other than that between the affected Party and its employees), transportation or
communication problems, or any other incident or act-of-God which is similar in nature or effect to any
of the foregoing (a "Force Majeure Event"). In case of a Force Majeure Event, the affected Party shall be
obliged to inform and notify the other Party of such situation and its provisional consequences. The
affected Party shall take reasonable steps to minimize the negative effects and consequences of any
Force Majeure Event, to the extent possible. This Section shall not apply to any obligation to pay money.
Limitation of Liabilities. NEITHER PARTY SHALL BE LIABLE FOR ANY CONSEQUENTIAL, INCIDENTAL,
INDIRECT, ECONOMIC OR PUNITIVE DAMAGES WHATSOEVER (INCLUDING BUT NOT LIMITED TO
DAMAGES FOR LOSS OF BUSINESS OR PERSONAL OR CONFIDENTIAL INFORMATION, OR ANY OTHER
PECUNIARY LOSS, DAMAGES FOR LOSS OF PRIVACY, OR FOR FAILURE TO MEET ANY DUTY, INCLUDING
ANY DUTY OF GOOD FAITH, OR TO EXERCISE COMMERCIALLY REASONABLE CARE OR FOR NEGLIGENCE)
ARISING OUT OF THIS AGREEMENT OR IN ANY WAY RELATED TO THE USE OF OR INABILITY TO USE
SERVICE(S), EVEN IF THE OTHER PARTY HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. THIS
LIMITATION SHALL BE EFFECTIVE EVEN IF ANY REMEDY FAILS OF ITS ESSENTIAL PURPOSE. IN NO EVENT
SHALL EITHER PARTY BE RESPONSIBLE FOR ANY AMOUNT OTHER THAN THE AMOUNT PAID OR OWED
TO THE OTHER PARTY UNDER THIS AGREEMENT FOR TRAVEL INVENTORY. EXCEPT AS EXPRESSLY
PROVIDED IN THIS AGREEMENT, SERVICE(S) IS/ARE PROVIDED “AS IS” WITHOUT ANY WARRANTY OF
ANY KIND. TO THE EXTENT PERMITTED BY LAW, ANY AND ALL WARRANTIES OF ANY KIND WHATSOEVER,
INCLUDING IMPLIED OR STATUTORY WARRANTIES, INCLUDING BUT NOT LIMITED TO THOSE OF
MERCHANTABILITY, OF FITNESS FOR A PARTICULAR PURPOSE, OF TITLE AND NON-INFRINGEMENT, OF
ACCURACY OR COMPLETENESS OF INFORMATION, OF REASONABLE CARE OR WORKMANLIKE EFFORT,
OF LACK OF NEGLIGENCE, AND/OR OF LACK OF VIRUSES, ALL WITH REGARD TO THE SERVICE(S), ARE
EXPRESSLY EXCLUDED.
Governing Law. This Agreement shall be governed by, and construed in accordance with, the laws of the
State of Florida, USA, and the parties consent to exclusive jurisdiction and venue in the courts in
Seminole County, Florida. Group waives all defenses of lack of personal jurisdiction and forum
nonconveniens. In any action to enforce any right or remedy under this Agreement, each Party shall
bear its own respective fees, costs and other expenses. Each Party hereby knowingly, voluntarily,
intentionally and irrevocably waives the right either of them may have to a trial by jury in respect to any
litigation, whether in contract or tort, at law or in equity, based hereon, or arising out of or relating to,
the Service(s), this Agreement or any other document, instrument, transaction, course of conduct,
course of dealing, statements (whether verbal or written) or actions of any Party hereto. This provision is
a material inducement for the Parties entering into this Agreement.
Itinerary/hotels/guides are subject to change (hotels of similar class may be used without
notice). Payments are non-refundable and non-transferable except as described above.
I understand and have read this document and its attachments: Enrollment Form, Mandatory
Travel/Health Insurance and Cancellation Fees and Changes Policies.
Signature: _______________________________________Date: ______________________________