Adventure Travel Trip Application
Participant: please print, sign and mail (or digitally sign and submit) to Trip Leader.
Keep a copy for yourself.
Memorial Day: Great Sand Dunes National Park
05/28/2016-05/30/2016
Leader:Svetlana Ehrhart
Address: 12342 E. Vassar Dr. Aurora, CO. 80014
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
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 Department and decide their own level of risk.
The CMC goes to great lengths to 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.
Payment and Cancelation Policy
Once you decide you are going to join the trip, please pay $355 to the CMC.
If you need to cancel (up to 4 days before the trip), $50 cancellation fee will be charged.
No cancellation can be made 3 days or less before the trip.
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.docx4/2/2015