AT Participant Application

Adventure Travel Trip Application

Participant: please print, sign and mail (or digitally sign and submit) to Trip Leader.
Keep a copy for yourself.

A Hiking Sampler of Slovenia

August 26 - September 11, 2017

Leader:Denise Snow

Address: 1774 County Road 51, Divide, CO 80814

e-mail:

Name: ______

Address: ______

Phone: (Day) ______(Evening) ______

Email address: ______

Gender: ☐Male ☐Female Age: _____ Occupation: ______

(For foreign trips only)
Passport Number: ______Expiration Date: ______
Passport must be valid for 6 months after departure of destination country.
Place of Issue: ______Date of Issue: ______

Emergency Contact:

Name: ______

Phone: ______

Relationship: ______

State of health (applicant must disclose all medical conditions which may affect the success of this trip):

______

List of medications you are taking: ______

Allergies:______Medical concerns:______

CMC Member? ☐Yes ☐No (If you are not a CMC Member you will need to sign the Guest Release of Liability Waiver and add 3% to the cost of the trip. Consider becoming a member to avoid this fee.)

Member #: ______CMC Group affiliation (e.g. Denver, Boulder): ______

Describe your background in outdoor activities as it relates to this trip (e.g. camping, hiking, backpacking, and mountaineering):

Your fitness level (select one): ☐Excellent ☐Good ☐Fair

Give a detailed overview of hard/long hikes or climbs done since June 2015 or that you plan to do between now and the fall of 2017. Describe your daily or weekly training regime. Use the back of this sheet or another sheet if needed:

Character and fitness reference (Please give contact information for at least one reference, preferably two or more) :

Dietary restrictions, food allergies, dietary preference(note: dietary restrictions may not be able to be accommodated): ______

Personal Risk Statement

The world can be a dangerous place. Participants are responsible for making their own travel decisions. Participants should keep themselves apprised of travel restrictions and warnings announced by the State Departmentand decide their own level of risk.

The CMC goes to great lengthsto provide safe, quality domestic and international cultural, educational and adventure trips. Before trips are sanctioned by the CMC, trip leaders are screened for their qualifications to lead the trip and their trip proposals are carefully considered. Every effort is made to assure the trip will go as announced.

One risk is that sometimes trips must be canceled by the CMC or the trip leader for a variety of reasons. These may range from failure to meet the trip’s minimum participation requirement to political unrest in the destination country.

A$500deposit is due upon receipt of approval for the trip.

Payment of $1500is due in the CMC office on February 15, 2017. Leader will send an email reminder.

Final payment will be due on July 14, 2017.

Cancellation on or before February 15, 2017: if a wait list-listed person takes your place, all payments will be returned (less a $50 change fee). If no replacement is available, $400will be refunded.

CancellationFebruary 16, 2017 through May14, 2017 inclusive: if a wait list-listed person takes your place, all payments will be returned (less a $50 change fee). If no replacement is available, $1800will be refunded.

Cancellation May 15, 2017 through Julu 14, 2017 inclusive: if a wait list-listed person takes your place, all payments will be returned (less a $50 change fee). If no replacement is available, $550 will be refunded.

Cancellationon or afterJuly 15, 2017 inclusive: no refund if cancelled on or after July 15, 2017.

Participants are strongly encouraged to purchase travel/cancellation/evacuation insurance.
After you are accepted on the trip, don’t wait to purchase your travel insurance!

Please sign and date the application, and return it to the trip leader. You cannot sign up for the trip with CMC until the trip leader approves this application.

I have read and agree to the Personal Risk Statement and the Payment and Cancelation Policy.
I have completed this application truthfully.

______

SignatureDate

AT Participant Application.docx1/29/2019