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REGISTRATION
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nformation private
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Name of Tour
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-Select One-
Greater Antilles Megatour
Dominican Republic
Puerto Rico
Jamaica
Bahamas
Lesser Antilles
Private Tour
Including Tour Extension (if applicable)
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-Select One-
Yes
No
Starting on: MM/DD/YYYY
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Ending on: MM/DD/YYYY
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Deposit Information
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1 Person (One island = $1000)
1 Person (Multi-island = $1000)
1 Person (Full Payment)
2 Persons (One island = $2000)
2 Persons (Multi-island = $2000)
2 Persons (Full Payment)
Private Tour
Other
Payment must be made upon form submission. If registering for a tour to be conducted in less than 120 days (150 for private or multi-island tours), you must pay in full at the time of registration.
Person I: Title (Mr/Mrs/Ms/Miss or other)
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Name to be Known by on the Tour
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Person II: Title (Mr/Mrs/Ms/Miss or other)
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Name to be Known by on the Tour
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Full Name
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Date of Birth: MM/DD/YYYY
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Mailing Address
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Full Name
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Date of Birth: MM/DD/YYYY
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Mailing Address
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City
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State/Province
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Zip/Postal Code
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Country
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Phone: Home
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Mobile
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Work
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Email Address
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City
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Zip/Postal Code
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State/Province
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Country
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Phone: Home
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Mobile
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Work
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Email Address
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Passport I Number
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Passport II Number
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Name as on Passport
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Name as on Passport
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Issuing Country
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Issuing Country
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Date of Issue
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Expiration Date
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Date of Issue
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Expiration Date
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Profession/ Retired
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Profession/ Retired
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Nationality
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Nationality
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Room Options
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-Select One-
I need a single room, where possible, at additional cost (Single Occupancy Supplement required).
I have a roommate and we desire 1 (one) bed.
I have a roommate and we desire 2 (two) beds.
I want WILLIAM SUAREZ BIRDING TOURS to provide a roommate, but if not possible, I will accept a single room and the Single Occupancy Supplement charge.
I/We Smoke
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-Select One-
Yes
No
I/We Snore
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-Select One-
Yes
No
Name
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Relationship
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Email
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Phone: Home
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Mobile
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Work
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PLEASE LIST ANY HEALTH PROBLEMS WHICH MIGHT AFFECT YOUR ABILITY TO COMPLETE OR ENJOY THE TOUR AND ANY SPECIAL DIETARY NEEDS
Comment
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I/We registered voluntarily to participate in this birding tour and recognize, agree and assume at all times by signing below that:
I/We will be traveling to a foreign country as part of a birding group and will conduct my/ourself in a manner that respects the constraints and ethics of this situation. I/We take full responsibility for my/our own actions, safety and welfare, and in any case will not endanger the group, my/ourself, public or private property, or any element of the local flora and fauna. I/We will be in remote geographic localities where medical care may be totally absent and therefore medical care and/or evacuation may not be available during, or after, specific events related to my/our health. It is entirely my/our responsibility to conduct research related to and obtain current health information about the country to be visited prior to travel, by, for example, contacting my/our family doctor and visiting the CDC web site for updated health and travel advice. I am/We are in good health and physical condition sufficient to participate in this tour and do not have any physical disability, medical condition, or any other limiting factor, except those related in the online Registration. If I/We omitted any other limiting factor, I/We may be removed prior to, or during the trip, at my/our own expense. I/We understand that WILLIAM SUAREZ BIRDING TOURS LLC, is not responsible for my/our medical care or medical expenses or for any investigation or claims related to health insurance.
I/We understand that many risks are inherent in the activities to be undertaken by us/ me, such as loss of flight reservations (due to travel delays going to or returning from the birding trip destination, cancellation of the tour), theft or loss of belongings, accidents by land vehicle or boat during transportation, misfortune, natural disasters, weather conditions, contact with wildlife including insect bites and hazardous plants, disease, illness, personal injury (due to physical exertion, hiking, climbing, snorkeling, swimming, alcohol consumption, political unrest, civil disturbances, wars, terrorism), and death. This list of risks is meant to be illustrative and is not comprehensive of all such potential risks.
I/We accept full responsibility for such specified inherent risks as well as for those not specifically identified here and potentially associated with this tour by signing below this online Registration. Therefore, it is my/our intention to fully assume all risk of the above mentioned tour and I/We do not hold WILLIAM SUAREZ BIRDING TOURS LLC, of Palm Beach
County, Florida
, its agents,
servants, employees,
shareholders, officers, directors, attorneys and contractors, past, present and future, and its respective heirs, legal and personal representatives, successor and assigns (collectively, "Released Parties"), responsible for any and all claims, actions, causes of action, demands, rights, damages, costs, losses, liabilities, expenses, compensation, controversies, disputes, obligations, debts, dues and liens whatsoever related to my/our properties, assets and interests ("Released Property"), on account of, or in any way arising out of, any and all known and unknown, foreseen or unforeseen loss of life or personal injury, loss or damage to property, and the consequence thereof, directly or indirectly, resulting from, incident to, in connection with, or arising out of my participation in the tour (collectively, "Claims"). It is my/our intention that this Release and Indemnity Agreement shall apply to all of the claims without limit and, to the fullest extent permitted by applicable law, regardless of whether founded, in whole or in part, on any negligent act or omission of any of the released parties. I/We have read, understand, and accept the Terms and Conditions of WILLIAM SUAREZ BIRDING TOURS LLC, including deposit, cancellation and refund policies as described in the web site of the company and accompanying documents related to the above mentioned tour. I/We have read and understand this Release and Indemnity Agreement, which contains the entire and final agreement relating to the subject matter hereof. Its terms shall be binding on me/us and on my/our heirs, legal representatives and assigns. Liability under this Release and Indemnity Agreement shall be joint and several. If any provision of this Release and Indemnity Agreement is determined to be void, unenforceable, ineffective or against public policy, that provision shall be disregarded and deemed removed from this Release and Indemnity Agreement and shall not affect the remaining provisions of this Release and Indemnity Agreement. The terms of this Release and Indemnity Agreement are contractual and not mere recitals. This Release and Indemnity Agreement shall be governed by and constructed under the laws of the state of Florida. Venue for enforcement of this Release and Indemnity Agreement shall be in Palm Beach County, Florida, United States of America. I/We have read this Release and Indemnity Agreement and agree and understand all the terms presented within it. I/We agree to be bound by the Release and Indemnity Agreement.
ATTENTION
By signing voluntarily this Registration and Release and Indemnity Agreement, the registrant agrees to be authorized to fully accept the conditions on behalf of any other person included in this online registration and understand the Terms and Conditions of WILLIAM SUAREZ BIRDING TOURS, including payments, refunds, cancellations and physical and medical requirements.
Full Legal Name of Registrant
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Date: MM/DD/YYYY
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