Registration form

Registration Form

(Just print this page out and Fax (412) 344-3937, copy and paste it into an email, or mail it in.)

Name:__________________________________________________ Birth Date ____/_____/______ [ ]Male [ ]Female
(as it appears on your passport)

How would you like your name to appear (informally) on our group passenger list_____________________________________________________________

Street: ________________________________________________________________ Apt # ______________________

City/State _____________________________________________________________ Zip ________________________

E-Mail________________________________ Phone: H _______________________ W ________________________

ACCOMMODATIONS:

Prefer: [ ] Single Occupancy

[ ] Double Occupancy* Roommate Request __________________________________________________

*Roommate Matching Available Upon Request

Post-Tour on Big Island of Hawai:

Prefer: [ ] Single Occupancy

[ ] Double Occupancy Roommate Request _________________________________________________

Trip Cancellation Insurance is optional but HIGHLY recommended. Info will be sent out with your confirmation.

PAYMENT:

[ ] Enclosed is my deposit of $500 per person (final payment due by 4/20/2006)

Pay your final payment by check and deduct $100 from your final payment!

or, [ ] Enclosed is my full payment: $________________ (make check payable to Amazing Journeys)

Charge my: [ ] Visa [ ] Master Card [ ] American Express [ ] Discover

Acct.# _______________________________________________________ Exp.Date _____________________

3 or 4 Digit Security Code ______________________

Signature _____________________________________________________

[ ] Check here is you prefer NOT to have your name, phone number and email on our Group Passenger List.

I've read, understand and agree to abide by all terms, conditions and information stated in the brochure.

Signature:_______________________________________________________ Date:_____/_______/_____

QUESTIONS AND REGISTRATION:

Call: Amazing Journeys at (800) 734-0493 or (412) 571-0220

or Bill Cartiff at the JCC of Greater Pittsburgh at (412) 521-8011 Ext. 849

E-mail: info@amazingjourneys.net or bcartiff@jccpgh.org

Mail: Amazing Journeys, 733 Valleyview Road, Pittsburgh, PA 15243

Fax: Amazing Journeys at (412) 344-3937 Visit: www.amazingjourneys.net

Responsibility: Notice is hereby given that the tour advertised herein, including all tickets, vouchers and coupons issued and all arrangements for transportation or conveyance or for hotel or lodging or for sightseeing services are made by Amazing Journeys, LLC/Jewish Community Center of Greater Pittsburgh as agency for various Hawaiian Hotels and/or suppliers providing services necessary for operation of the tour upon the express condition that Amazing Journeys/JCC shall not be liable for injury, damage, loss, accident, delay or irregularity to any tour participant or his or her property that may result from any act or omission of any company, contractor or employee thereof providing services in connection with the tour, including but not limited to transportation, lodging, food and beverage, entertainment, sightseeing luggage handling and tour guiding. Furthermore, Amazing Journeys/JCC cannot be held responsible for delays resulting from weather and road conditions, breakdowns, strikes, war, riots, acts of God, authority of law or other circumstances beyond its control. In the event that those participants who have made full or partial payment for the tour will be entitled to a full refund of monies paid, but under no circumstances will Amazing Journeys/JCC be liable for cancellation to a tour participant in excess of the amount paid. Amazing Journeys/JCC reserve the right to decline or retain any persons as a tour participant at any time. Amazing Journeys/JCC are not responsible for price increases imposed by our various hotels and tour operators or their vendors. Amazing Journeys/JCC are not responsible for breach of contract or any intentional or careless actions or omissions on the part of such suppliers or tour operators or other services used or obtained on or at the time of excursions, which result in any loss, damage, delay or injury to you or your travel companions or group members. We do not guarantee any such suppliers rates, booking or reservations and Amazing Journeys/JCC will not be responsible for any social or labor unrest, mechanical or constructions difficulties, diseases, local laws, climate conditions, abnormal conditions or developments or any other actions, omissions or conditions outside Amazing Journeys/JCC control. Above organizations may use photographs taken during this trip for publications on our web sites and/or in print advertising. By embarking upon his/her travel, the traveler voluntarily assumes all risks, and is advised to obtain appropriate insurance coverage against them. Retention of tickets, reservations, or package after issuance shall constitute a consent to the above and an agreement on your part to convey the contents hereof to your travel companions.