SCIF3900/AVIA3900
Aviation and Sustainable Tourism
Aviation and Sustainable Tourism is a unique course
designed to provide students with a field-led
development of skills in comprehending and
assessing the physical, social and economic
sustainability of societal decisions in the context of
the Great Barrier Reef marine park.
A field excursion to Lady Elliott Island will be
undertaken with the objective of allowing students
develop an inter-disciplinary understanding of the
challenges and strategies of sustainable transport
and tourism. The field excursion will be followed by
small group classes designed for reflective learning
on-campus.
Lady Elliot Island is a coral cay located at the
southern tip of the World Heritage Listed Great
Barrier Reef. Situated within a highly protected
‘Green Zone’ the island is a sanctuary for over 1,200
species of marine life. The island boasts a state-ofthe-art Reef Education Centre, which is where the
classes will be held during the excursion.
The four-nights field trip will include classes, on-site
marine observation and discussions on topic areas at
the interface of air and water transport logistics, reef
ecology, remote destination management and
sustainable tourism development.
When: February 17th – 21st 2016 (the week
preceding O-Week)
Cost of the excursion: AU$890.00 (subject
to minor variation). Includes 4 nights
accommodation, all meals, scenic return
flight from Hervey Bay to LEI, various island
activities, including education tours by
experienced island staff and academics.
SYD-Hervey Bay flights are available at
competitive rates: www.virginaustralia.com
Contact hours: 18 hours of class delivered
on the island and additional 24 hours
delivered on-campus between Week 1-8.
This 6UOC course concludes in Week 8 of
Semester 1 2016.
For more information, please contact School
of Aviation undergraduate program:
aviab@unsw.edu.au
For more information on Lady Elliot Island
visit their website:
http://www.ladyelliot.com.au
UNSW Handbook information:
Search “SCIF3900” or “AVIA3900”
http://www.handbook.unsw.edu.au
FACULTY OF SCIENCE
School of Aviation
SCIF3900/AVIA3900
Aviation and Sustainable Tourism
Session 1, 2016
Table of Contents
1. Information about the Course ......................................................................................................... 2
2. Staff Involved in the Course ............................................................................................................ 2
3. Course Details ................................................................................................................................... 3
Group report ........................................................................................................................................... 4
Presentation ........................................................................................................................................... 4
4. Rationale and Strategies Underpinning the Course .................................................................... 4
5. Course Schedule ............................................................................................................................. 5
6. Assessment Tasks and Feedback ................................................................................................. 6
7. Additional Resources and Support ............................................................................................... 7
8. Required Equipment, Training and Enabling Skills ..................................................................... 7
9. Course Evaluation and Development ............................................................................................ 8
10. Administration Matters ................................................................................................................... 9
11. UNSW Academic Honesty and Plagiarism ............................................................................ 10
1
Faculty of Science - Course Outline
1. Information about the Course
NB: Some of this information is available on the UNSW Handbook 1
Year of Delivery
2016
Course Code
SCIF3900/AVIA3900
Course Name
Aviation and Sustainable Tourism
Academic Unit
School of Aviation
Level of Course
3 year Aviation students, or
For non-Aviation students, minimum of 72 UoC at an approved University
Units of Credit
6
Session(s) Offered
Offered in session 1
Assumed Knowledge,
Prerequisites or Corequisites
AVIA1321 (applies to Bachelor of Aviation students only), or
For non-Aviation students, minimum of 72 UoC at an approved University
Hours per Week
Contact hours during field excursion 18 hours (equivalent to 6 weeks 3HPW)
Additional 24 hours delivered between Week 1 – Week 8 (3HPW)
Number of Weeks
9 weeks (including field excursion between 17-21 Feb 2016)
Commencement Date
18 February 2015
rd
st
Summary of Course Structure (for details see 'Course Schedule')
Component
HPW
Time
Day
TBA
TBA
17-21 February 2016
(inclusive)
TBA (Week 1-8)
TBA (Week 1-8)
Lady Elliott Island field excursion
Lecture
Tutorial
TOTAL
2
1
Location
LEI Eco-Education
Resort
TBA (on-campus)
TBA (on-campus)
3
2. Staff Involved in the Course
Staff
Course Convenors
Lecturers
1
Role
Name
Dr. Tay Koo
Prof. Jason Middleton
Contact Details
t.koo@unsw.edu.au
j.middleton@unsw.edu.au
Consultation Times
TBA
UNSW Online Handbook: http://www.handbook.unsw.edu.au
2
3. Course Details
Course Description
(Handbook Entry)
Course Aims
2
3
Student Learning
4
Outcomes
This course offers an introduction to concepts and tools necessary for understanding the
challenges of sustainable development in the transport-environment-tourism nexus. Students will
develop skills in comprehending and assessing the environmental, social and economic
sustainability of societal decisions in the context of the Great Barrier Reef marine park and
regional tourism in Australia. A field excursion to Lady Elliott Island – located in the Southern tip
of the Great Barrier Reef - will be undertaken with the objective of allowing students develop an
interdisciplinary understanding of these societal trade-offs. The field-based learning will
emphasise teamwork, as well as independent observational and enquiry skills using remote ecoresort as a context. Topics will include issues at the interface of aviation and transport logistics,
reef ecology and sustainable destination management. Students will engage in reflective learning
through follow-up lectures and assignments during semester. Students should be aware that
additional costs associated with the field trip will be incurred including return airfare to Lady Elliott
Island (LEI), accommodation and food.
This course is designed to provide students with a field-led understanding of the challenges of
sustainable development with emphasis on sustainable transport and tourism management.
Specifically, the course aims to provide students with an introduction to concepts and tools
necessary for an understanding of aviation-environment-tourism nexus, using air transport
operations and ecotourism in the Great Barrier Reef as an illustrative context. LEI represents a
microcosm of human-environment interactions. The eco-tourism resort is particularly well suited
for learning outcomes targeted at developing field-based observation skills, exposure to
interdisciplinary knowledge and how these knowledge are used for the balancing of the
economic, social and environmental goals. Students will develop skills in comprehending and
assessing the physical, social and economic sustainability of societal decisions. Although the
main focus of the field excursion is on the Great Barrier Reef marine park, case studies and
examples will be drawn from a wide array of Australian and global destinations, including remote
aboriginal communities.
1. Demonstrate capacity of critical thinking with respect to the trade-offs between economic,
social and environmental considerations through completion of fieldwork, assignments and tasks
in sustainable transport and tourism management.
2. Develop skills in the use and interpretation of principles, techniques and methods for
assessing sustainable development using transport operations and ecotourism in the Great
Barrier Reef as an illustrative context.
3. Develop skills in independent observation and enquiry in identifying and understanding the
sustainable management challenges of a reef eco-tourism resort.
4. Through observation and questioning, develop the capacity to appreciate the layers of
complexity involved in the sustainable management of transport and tourism
5. Enhance and refine skills in extracting relevant information for a given task, both on the field
and desktop research following the field trip.
6. Develop written and spoken communication as well as teamwork skills, as relevant to the
interdisciplinary challenges of the aviation-tourism-environment nexus.
7. Through the study of tourism and tourist behaviour, develop a broader view of the impact of
aviation on sustainable development
Graduate Attributes Developed in this Course
Science Graduate
5
Attributes
Research, inquiry and
analytical thinking
abilities
Capability and motivation
for intellectual
development
Ethical, social and
professional
5
Select the level of
FOCUS
Activities / Assessment
0 = NO FOCUS
1 = MINIMAL
2 = MINOR
3 = MAJOR
3
2
2
Group research report
Individual field report
Final exam
Group research report
Individual field report
Final exam
Group research report
Individual field report
2
UNSW Handbook: http://www.handbook.unsw.edu.au
Learning and Teaching Unit: Course Outlines
4
Learning and Teaching Unit: Learning Outcomes
5
Contextualised Science Graduate Attributes
3
3
understanding
Communication
2
Teamwork, collaborative
and management skills
Information literacy
2
3
Major Topics
(Syllabus Outline)
1.
2.
3.
4.
5.
6.
7.
Group presentation
Group report
Presentation
Daily reflection (diary)
Group report
Individual field report
Group research report
Final exam
Daily reflection (diary)
Sustainable development principles and theories: applications to aviation and tourism
Basic ecology and physical geography of the reef environment
Operations management challenges of remote transport and destinations
Market failure and Tragedy of the Commons
Environmental values and discourse in aviation and tourism
Sustainable destination management strategies and techniques
Case studies in (un)sustainable island transport and tourism management
Relationship to Other
Courses within the
Program
4. Rationale and Strategies Underpinning the Course
Teaching Strategies
Several different methods are used in the course to assist in achieving student learning
outcomes. Individual field report, along with daily reflection diary, is designed to help students
develop independent field-based observation and inquiry skills, as well as refine scientific writing
skills. Each class will have allocated readings, exercises and self-review questions to assist
students achieve learning outside class times and provide a logical structure for the topics and
concepts introduced in the course. The group project is designed to provide a context in which
students can apply learning from class and assist students appreciate and evaluate varying
perspectives, with the goal of promoting independent learning in identifying and defining
problems, analysing problems, and reviewing and applying information learnt in class. The final
test will assess student level of understanding and knowledge through short essay questions.
Rationale for learning and
6
teaching in this course ,
Teaching methods are designed to provide students with an introduction to core concepts and
theories that will help students develop a deeper understanding of a selection of key issues in
aviation and sustainable tourism. Practical examples will be used where appropriate. This course
requires students undertake a University-organised 5 day field excursion to Lady Elliot Island,
Queensland. The learning and teaching in this course builds on the experiences gained during
the field-trip. In the subsequent classes on-campus, it is expected that students prepare for each
class by completing reading and self-review exercises.
6
Reflecting on your teaching
4
5. Course Schedule (please note: lecture sequences and contents subject to minor variations)
7
8
Some of this information is available on the Online Handbook and the UNSW Timetable .
Please note: lecture topics and sequences are subject to minor changes
Week
Lectures (From Week 1)
Tutorials (Week 1)
Assignment and Submission
dates (see also 'Assessment
Tasks & Feedback')
Group presentation (TBA)
Week 1
Sustainable development
principles and applications
Post field-trip summary
Daily reflection due (Sunday of
Week 1 11:59pm via Moodle)
Week 2
Economic and financial
sustainability
Week 3
Social and cultural sustainability
Sustainable development
principles and
applications/group assignment
Economic and financial
sustainability
Week 4
Environmental discourse and
aviation
Social and cultural sustainability
Week 5
Assessing tourism sustainability
Environmental discourse and
aviation
Week 6
Special topic
Assessing tourism sustainability
Week 7
Special topic & review
review
Week 8
Exam
17-21 February 2016
Individual essay due (Sunday
of Week 3 11:59pm via Moodle)
Group report due (Sunday of
Week 6 11:59pm via Moodle)
In-class exam during normal
lecture hours
Week 9
Week 10
Week 11
Week 12
7
8
UNSW Virtual Handbook: http://www.handbook.unsw.edu.au
UNSW Timetable: http://www.timetable.unsw.edu.au/
5
6. Assessment Tasks and Feedback
Task
Learning
outcomes
assessed
Assessment Criteria
% of
total
mark
Date of
Release
Submission
Feedback
WHO
WHEN
HOW
Individual essay
1,2,3,4
To be advised (during
field excursion)
20%
February
2016
Due Sunday week 3
11:59pm
Presentation
1,2,4,6
To be advised (during
field excursion)
10%
February
2016
Due 22 February
TK/JM
Simple releve analysis
3,4,5
To be advised (during
field excursion)
5%
February
2016
TBA
JM
Group assignment
1,3,5,6
To be advised (Week 2)
25%
February
2016
Due Sunday week 6
11:59pm
TK
Within two
weeks of
submission
Moodle
Daily reflection
1,2,4
To be advised (during
field excursion)
10%
February
2016
Due Sunday week 1
11:59pm
TK
During
field
excursion
Moodle
Final exam
1,2,3
To be advised
30%
Week 8
Normal lecture time
week 8
TK
nd
TK
Within two
weeks of
submission
In-person
during
fieldexcursion
In-person
during
fieldexcursion
In-person
during
fieldexcursion
In-class
6
7. Additional Resources and Support
Text Books
N/A
Course Manual
Essential readings will be provided during field excursion, as well as via Moodle
Required Readings
Essential readings will be provided during field excursion, as well as via Moodle
Additional Readings
Additional reading references will be provided via Moodle
Recommended Internet
Sites
GBR Marine Park Authority http://www.gbrmpa.gov.au/
United Nations World Tourism Orgnisation: www.unwto.org/en
Sustainable Tourism CRC online publications http://www.crctourism.com.au/
Tourism Queensland: http://www.tq.com.au/
Lady Elliott Island: http://www.ladyelliot.com.au/
Societies
Computer Laboratories or
Study Spaces
N/A
8. Required Equipment, Training and Enabling Skills
Equipment Required
N/A
Enabling Skills Training
Required to Complete this
Course
N/A
7
9. Course Evaluation and Development
Student feedback is gathered periodically by various means. Such feedback is considered carefully with a view to acting on it
constructively wherever possible. This course outline conveys how feedback has helped to shape and develop this course.
Mechanisms of
Review
Major Course
Review
CATEI
9
Other
Last Review
Date
Comments or Changes Resulting from Reviews
Reviewed 2015
Based on CATEI and direct student feedback, the course introduced new syllabuses:
environmental discourse in aviation; logistics modeling of island operations; and tourism risk
and disaster management
The CATEI system will be used to evaluate the course at the end of the course.
Feedback will be sought from students in-class
9
CATEI process
8
10. Administration Matters
Expectations of Students
Students should be familiar with the information contained in <https://my.unsw.edu.au>
regarding expectations of students, assignment submission, examination procedures, equity and
diversity and other policies that affect you.
Assignment Submissions
The assignments should be word-processed and include a standard title page. They must be
submitted via Blackboard. Only under special circumstances should assignments be handed in
via email to the lecturer. Application for an extension of time should be made in writing prior to
the due date. Late assignments, without a reason deemed satisfactory by the lecturer, will be
penalised by a loss of 10% of total possible marks per day. Assignments will attract no marks if
they are submitted after other assignments have been marked and returned, or two weeks after
the due date (whichever is the earlier). Students are referred to the University's Student
Handbook for full details on academic regulations.
Occupational Health and
10
Safety
N/A
Assessment Procedures
Students are expected to be regular and punctual in attendance at all classes. All applications
for exemption from attendance at classes of any kind must be made, in writing, to the Lecturerin-Charge. An attendance form must be signed by attending students at each lecture.
In order to ensure a Pass in the course, students must miss no more than two classes, without
reasons deemed satisfactory by the lecturer.
Special Consideration. In case of absence from the class test, a request for special
consideration may be made only in accordance with the University's standard guidelines.
UNSW Assessment
11
Policy
Equity and Diversity
Those students who have a disability that requires some adjustment in their teaching or learning
environment are encouraged to discuss their study needs with the course Convenor prior to, or
at the commencement of, their course, or with the Equity Officer (Disability) in the Equity and
Diversity
Unit
(9385
4734
or http://www.studentequity.unsw.edu.au/ http://www.equity.unsw.edu.au/disabil.html).
Issues to be discussed may include access to materials, signers or note-takers, the provision of
services and additional exam and assessment arrangements. Early notification is essential to
enable any necessary adjustments to be made. Information on designing courses and course
outlines that take into account the needs of students with disabilities can be found at:
http://www.guidelinesonlearning.unsw.edu.au/guideline8.cfm
Student Complaint
12
Procedure
School Contact
Faculty Contact
University Contact
Elaine Chau
Undergraduate Studies
School of Aviation
A/Prof Julian Cox
Associate Dean (Education)
julian.cox@unsw.edu.au
Tel: 9385 8574
or
Dr Scott Mooney
Associate Dean
(Undergraduate Programs)
s.mooney@unsw.edu.au
Tel: 9385 8063
Student Conduct and Appeals
Officer (SCAO) within the
Office of the Pro-ViceChancellor (Students) and
Registrar.
Phone: + 61 2 9385 6767
Email: aviab@unsw.edu.au
Telephone 02 9385 8515,
email studentcomplaints@uns
w.edu.au
University Counselling and
13
Psychological Services
Tel: 9385 5418
10
UNSW OHS Home page
UNSW Assessment Policy
12
UNSW Student Complaint Procedure
13
University Counselling and Psychological Services
11
9
11. UNSW Academic Honesty and Plagiarism
What is Plagiarism?
Plagiarism is the presentation of the thoughts or work of another as one’s own.
*Examples include:
• direct duplication of the thoughts or work of another, including by copying material, ideas or concepts from a book,
article, report or other written document (whether published or unpublished), composition, artwork, design, drawing,
circuitry, computer program or software, web site, Internet, other electronic resource, or another person’s assignment
without appropriate acknowledgement;
• paraphrasing another person’s work with very minor changes keeping the meaning, form and/or progression of ideas of
the original;
• piecing together sections of the work of others into a new whole;
• presenting an assessment item as independent work when it has been produced in whole or part in collusion with other
people, for example, another student or a tutor; and
• claiming credit for a proportion a work contributed to a group assessment item that is greater than that actually
contributed.†
For the purposes of this policy, submitting an assessment item that has already been submitted for academic credit
elsewhere may be considered plagiarism.
Knowingly permitting your work to be copied by another student may also be considered to be plagiarism.
Note that an assessment item produced in oral, not written, form, or involving live presentation, may similarly contain
plagiarised material.
The inclusion of the thoughts or work of another with attribution appropriate to the academic discipline does not amount to
plagiarism.
The Learning Centre website is main repository for resources for staff and students on plagiarism and academic honesty.
These resources can be located via:
www.lc.unsw.edu.au/plagiarism
The Learning Centre also provides substantial educational written materials, workshops, and tutorials to aid students, for
example, in:
• correct referencing practices;
• paraphrasing, summarising, essay writing, and time management;
• appropriate use of, and attribution for, a range of materials including text, images, formulae and concepts.
Individual assistance is available on request from The Learning Centre.
Students are also reminded that careful time management is an important part of study and one of the identified causes of
plagiarism is poor time management. Students should allow sufficient time for research, drafting, and the proper referencing
of sources in preparing all assessment items.
* Based on that proposed to the University of Newcastle by the St James Ethics Centre. Used with kind permission from the University of
Newcastle
† Adapted with kind permission from the University of Melbourne
10
SCIF/AVIA3900: Aviation and Sustainable Tourism
Field Trip to Lady Elliot Island 17 - 21 February 2016 (the week preceding O-week)
The UNSW School of Aviation is offering a newly developed course in Semester 1 2016 entitled ‘Aviation
and Sustainable Tourism’. This 6-credit course, which includes a field trip to Lady Elliot Island (LEI) on
the Great Barrier Reef, will have classes during the first half of Semester only. This allows the student to
complete the coursework earlier and thereby concentrate on their remaining 18 credits for the latter half of
the Semester.
The ‘Aviation and Sustainable Tourism’ course offers an introduction to concepts and tools necessary for
understanding of the challenges and strategies of sustainable transport and tourism. The field excursion to
LEI is undertaken with the objective of allowing students develop an inter-disciplinary understanding of
the aviation, environment and tourism relations in the Great Barrier Reef.
Students will develop skills in comprehending and assessing the physical, social and economic
sustainability of societal decisions in the context of the Great Barrier Reef marine park. The field-based
learning emphasizes teamwork, as well as independent observational and enquiry skills using the remote
eco-resort as a context.
The four-nights field trip will include classes, on-site marine observation and discussions on topic areas at
the interface of air and water transport logistics, reef ecology, remote destination management and
sustainable tourism development. Students will engage in reflective learning through follow-up lectures
and assignments during semester.
Lady Elliot Island (LEI) is the southernmost coral cay on the Great Barrier Reef, situated 80km northeast
of Bundaberg. Scuba diving and snorkeling are available on the island. In February students will also
observe the turtle and bird-nesting season.
It is strongly advisable that students arrive at least one day before the field excursion departure date
(which will be 17th February in 2016). UNSW campus accommodation usually opens in the week preceding
the O-week. Please check with UNSW campus accommodation on the exact date of opening.
Eligibility requirements
Any student who is accepted at UNSW is eligible to participate in this course (for Study Abroad students
this is 72 UoC at an approved University, for Aviation students the pre-requisite is AVIA1321). Please note
that this course can be taken as a Science Elective or General Education in Science. Please see the course
outline for further details. Students must be willing to attend and pay additional travel and living costs on
the field trip to Lady Elliot Island (see below).
Course Fees
The cost of the excursion fee in Semester 1, 2016 is AUD$895. A deposit of AUD$250 is required to secure
a place in the program. The deposit will not be refunded if you withdraw less than eight weeks prior to the
commencement date of the field trip. Final payment is due by the 15th December 2015.
Field trip fees include:
o 4 nights accommodation on LEI
o All meals on LEI (3 meals per day)
o Return flights - Hervey Bay to LEI (please note maximum luggage of 10kg/22 pounds per person)
o The Environmental Management Fee cost for the Great Barrier Reef
o Airport transfers in Sydney
o Study facilities and resources on the island
o Field trip administrative fees
o Education tours, including environmental management plant, reef walk, and many others
o Snorkeling gear and safety gears such as reef shoes and LEI cap for sun protection
Additional field trip fees not included: The fee does not include tuition (as these will be paid via the
normal format), return flights from Sydney to Hervey Bay, or personal expenses on LEI, such as scuba
diving and entertainment costs.
We recommend you purchase Virgin Australia flights because they are the most convenient:
DJ1555 on 17th FEB
Sydney to Hervey Bay 1010/1100
DJ1554 on 21st FEB
Hervey Bay to Sydney 1130/1420
To book these flights, please go to the Virgin Australia website (below) and select the appropriate flights
and date.
http://www.virginaustralia.com/au/en/
Please note: While it is strongly recommend that you purchase the Virgin Australia flights identified
above, if you are organizing an alternative route (e.g. via Brisbane or Bundaberg with Qantas) then please
ensure you arrive at Hervey Bay airport no later than 10:30am on the 17th Feb and leave no early than
11:30am on the 21st Feb: we must transfer you from Hervey Bay to Lady Elliot Island as a group.
The fare is currently priced at approx. $99.00-$119.00AUD one way plus a $9AUD credit card booking fee
(1st May 2015). Please take note of the luggage restrictions on the Virgin Australia flights.
Application Form - Aviation and Sustainable Tourism
Field Trip to Lady Elliot Island 17 - 21 February 2016
This application form needs to be completed and submitted with payment details to UNSW Study Abroad by post, fax
or email. Please also CC School of Aviation Undergraduate administration
Mail:
Fax:
Email:
UNSW Study Abroad
+61 2 9385 1265
studyabroad@unsw.edu.au
Ground Floor, Red Centre (East Wing)
The University of New South Wales
Sydney NSW 2052
Australia
Please CC School of Aviation
aviab@unsw.edu.au
Personal Details
Family name:
Given names:
Date of Birth (Day/Month/Year):
DD / MM / YYYY
Gender:
Zip/postcode:
Country:
 Male
UNSW Student ID Number:
Country of citizenship:
Contact address:
Is this your mailing address?
 Yes
 No
Any disabilities that UNSW Study
Abroad should be aware of:
 Yes
 No
Will you be on medication during the
field trip that UNSW Study Abroad
should be aware of?
 Yes
 No
Do you have certified scuba diving
accreditation?
 Yes
 No
Telephone (include prefix codes):
E-mail (please print clearly):
If yes, please attach a letter explaining any support required.
If yes, please provide details:
 Female
Aviation and Sustainable Tourism
Field Trip to Lady Elliot Island 17 - 21 February 2015
Current University/College
University/College name:
UNSW
Your address at University/College:
(Indicate “as above” if same as home
address)
Zip/postcode:
Is this your mailing address?
 Yes
Country:
 No
Declaration and signature
o
o
I understand that on completion of this application I hereby exempt, release and discharge the University of New
South Wales, its servants, agents and contractors, liability for any injury, loss, damage or expense sustained by
me to person or property during, or as a result of, my participation in the Aviation and Sustainable Tourism
Field Trip to Lady Elliot Island.
I also understand at the time I accept an offer of a place on the Aviation and Sustainable Tourism Field Trip to
Lady Elliot Island, I will be accepted and enrolled at UNSW for the same semester as the field trip for which I
apply.
Signature: __________________________________________________ Date: ______________________________
Tuition fee payment details
Please select the payment you would like make in order to secure a place in the pre-semester course:

AUD$250 as a deposit to be held by UNSW Study Abroad (A transaction will not be placed on your credit card
initially. This deposit information is held until you finalise your enrolment and make $895 payment to Lady Elliot
Island).

AUD$895 (The balance will be taken by the Lady Elliot Island Eco Resort on 15th January, 2016)
Payment method (Visa or MasterCard only)
Student name:
Card type:
 Visa
 MasterCard
Other:
Cardholder name:
Card number:
Expiry date (MM/YY):
Card CVC (three digits):
Cardholder Signature:
Date: