Application

Release and Assumption of Risk
I am aware that during this trip I am participating under the arrangement of Integral Expeditions. Certain risks and dangers may occur including but not limited to the hazards crossing mountains, accident or illness in remote places without medical facilities or means of rapid evacuation, the dangers of civil disturbance and war, the forces of nature and travel by air, automobile, bus and other conveyance. In consideration of the right to participate in such a trip and the services of Integral Expeditions, I have and do hereby assume all of the above risks and will hold them harmless from any and all liability actions, causes of actions, debts, claims of demand of every kind of nature whatsoever which I now have or which may arise of or in connection with my participation on this trip. The terms thereof shall serve as a release and assumption of risk for my heirs, executors, and administrators and for all members of my family. I acknowledge that I have been advised that California has a Travel Consumer Restitution Fund and that my tour is not covered by that law because the foreign providers of transportation and travel services utilized for this tour are not registered as Sellers of Travel in California. I understand that I am not eligible to make any claim against that fund.

If you would rather send this document via regular mail please print and fill out this document: Printable Application

PROGRAM/WORKSHOP DESTINATION:		DATE OF TRIP (MM/DD/YYYY) :
YOUR NAME (AS IT APPEARS ON PASSPORT : )		BIRTH DATE (MM/DD/YYYY) :
ADDRESS :		PHONE (HOME) :
CITY :		PHONE (WORK) :
STATE :		EMAIL :
ZIP or COUNTRY CODE :

HOW WERE YOU REFERRED TO US?:
PASSPORT NUMBER ::		EXPIRATION DATE (MM/DD/YYYY) :

OCCUPATION :		LICENSE NUMBER :
REQUESTING CEU’S OR PD POINTS: (IF APPLICABLE)
WILL YOU BE ATTENDING THE WORKSHOP?: (IF APPLICABLE)	Yes No

DESCRIBE YOUR HEALTH, (ALLERGIES, MEDICATION, ETC) :

IN EVENT OF EMERGENCY CONTACT :		EMERGENCY CONTACT' PHONE :

NAME OF TRAVELLING COMPANION (IF APPLICABLE) :		COMPANION PHONE :
COMPANION'S EMAIL ADDRESS :		FLIGHT ARRIVAL DATE: (mm/dd/yy)	FLIGHT:
		FLIGHT DEPARTURE DATE: (mm/dd/yy)	FLIGHT:
SINGLE OR DOUBLE OCCUPANCY? :	Single Double Please note that single occupancy rooms are limited and may not be available for all registrants. Contact us for more information.

I understand that there is a minimum number of registrants required for each trip to go forward and that if a trip is canceled due to insufficient numbers and I have used a credit card to pay for the program, a full refund will be given, less administrative fees. I have read and agree to the conditions stated above. :