forma by pengxuebo


6741 W.Belmont Ave.
Chicago IL 60634                            REGISTRATION FORM
Tel. 773-237-7788                            FORMULARZ REJESTRACYJNY

Name of participant ___________________________________________
imię i nazwisko uczestnika
TEL ( ____ ) ___________ TEL ( ____ ) ____________

Address ___________________________________STATE______ ZIP_______
adres zamieszkania
Physical conditions EXOTICA TRAVEL should be aware of _______________________________
choroby i doleglowości, o których biuro EXOTICA TRAVEL powinno wiedzieć:
Medical insurance ubezpieczenie medyczne
participant’s agency name (policy number) nazwa agencji ubezpieczeniowej (numer polisy)
purchased for the time period of the event: from _____________ to: __________
ubezpieczenie wykupione na czas od-do
Insurance name _____________________________ (Insurance coverage: emergency medical, dental up
to $10,000 )
none (bez ubezpieczenia)
Medical/liability release and acknowledgment of risk: I hereby certify that the above named enrollee is in good health and
free from any communicable disease. In case of medical emergency (taking place during the course of the event) I hereby
give permission to representatives of Exotica Travel to secure proper treatment for enrollee. I also certify that my insurance
company or myself will cover all medical costs. I acknowledge that some of the activities provided by Exotica Travel, e.g.
skiing, rafting, canoeing, swimming, horseback riding, hiking, biking, and others, may entail known and unanticipated risks
which could result in physical or emotional injury, paralysis, death, or damage to myself or participant, and/or to property,
equipment or to third parties. I understand that such certain risk cannot be eliminated without jeopardizing the essential
qualities of the activity. I expressly agree and promise to accept and assume all of the risks existing in this activity and
certify that my participation in this activity is voluntary and I elect to participate in the activities despite the risks involved. I
also hereby voluntarily release, forever discharge and agree to indemnify and hold harmless Exotica Travel from any and
all claims, demands, or causes of action that may be in any way related to or result from my participation in any activity.
I hereby release Exotica Travel, it s representatives, and owners of any facility used by Exotica Travel from any and all
Responsibility: Exotica Travel and/or it s agents act only as an agent in making arrangements for hotels, sightseeing tours
and transportation or any other service in connection with the event. Exotica Travel and/or its agent or suppliers shall not
be liable for injury, death, damage, loss, accident, delay or irregularity, liability or expense to person or property due to act
or default of any hotel/motel or other accommodation property, carrier or other company or person providing or rendering
services included in the event, or any and all acts of a third party. Further, the sponsoring organization and/or its agents
accept no responsibility for any sickness, labor disputes, defect in any vehicle of transportation, or for any misadventure or
casualty, or any other cases beyond their control. Exotica Travel reserves the right to cancel, change, or substitute any
service and to decline to accept or retain any event member at any time for any reason including insufficient number of
participants. Your registration provides Exotica Travel the authorization to use photos and videos of you and your
registered participants for promotional purposes. This document is valid for each event organized by Exotica Travel until
year of 2016, but each time of participation, updating all necessary information about participant is responsibility of
We strongly recommend that all travelers purchase any TRAVEL INSURANCE to protect against the risk of medical
expenses, death, travel delays, trip cancellation, any damage, loss of baggage or personal belongings, etc.
I understand and accept all terms and conditions presented to me in the English language explained in REGISTRATION
FORM as well as in GENERAL INFORMATION AND CONDITIONS, on the reverse side of this page.
Rozumiem i akceptuję wszystkie warunki i zasady przedstawione mi w języku polskim lub angielskim w FORMIE

date and signature of participant
data i podpis uczestnika / lub w imieniu uczestnika / lub w przypadku nieletnich podpis w imieniu rodziców lub opiekunów
                          General Information and Conditions about tours organized by EXOTICA TRAVEL
                                       (OGÓLNE INFORMACJE I WARUNKI UCZESTNICTWA)

RESERVATIONS & PAYMENTS: A deposit and Passenger Reservation Form (Formularz Rejestracyjny) are required to secure a
reservation. Reservations are taken on a first come-first served basis. FULL payment for tour must be received at EXOTICA Travel office, no
later than 45 days prior to departure date of the tour. Reservations may be canceled and we reserve the right to levy full cancellation charges
as set forth in these conditions if full payment is not received 45 days prior to the departure date. Based upon availability, a reservation
received less than 45 days prior to the departure date of the tour will be subject to a $50 late fee and must be paid in full. Payments can be
made by check, money order or cash.
ROOMS: Prices are based on double occupancy. Single rooms are available at a supplementary cost, or as stated on individual
itineraries. On those rare occasions when we are not able to get a roommate for you, you will be required to pay the single supplement. We
will attempt to give sufficient prior notice to any room changes regarding double occupancy versus single supplement. Triple rooms may not
be available in all countries.
TAXES: Airport Departure Tax is not included to the price of our tours. Please see individual itineraries for prices.

TIPPING: The price of the tour does not include tips and gratuities. In some countries tipping is recommended to the Tour Guide and Driver
approximately $3 per person per day to each. Gratuities for meals and room service are not included.
INSURANCE: Insurance is not included in the tour price. We strongly recommend that you purchase the travel insurance package which we
offer. Please note, that we can not accept responsibility for any loss or expense which you or any member of your party may incur as a result
of failing to secure adequate insurance coverage. We reserve the right to increase the insurance fee, if business conditions require.
MEDICAL CONDITION: While we endeavor to provide high level of service to all our passengers, we cannot guarantee special facilities or
assistance for disabled passengers and it is your responsibility to arrange for such assistance or special needs as you may
require. EXOTICATRAVEL is not responsible for any medical conditions that occur prior, during or after the tour.
CANCELLATION: All cancellations must be in writing to us and must be signed by the person who made the original
reservation. Cancellations are only effective from the day they are actually received by U.S. Postmark prevails. No refunds are issued for
cancellations received after the departure date of the tour. Penalties will apply. If you cancel your tour, cancellation fees and penalties will be
deducted from your refund. Cancellation fees will apply to deposit checks. (Airline penalties could be total cost of airline ticket.) Cancellation
fees apply to each person.

60 days or more $25
45 days or more $200.00
7 days or more at least 75% of the tour price
6 days or less NO FEFUND

Travel insurance fees are non-refundable. EXOTICA TRAVEL reserves the right to cancel a tour. Penalties are not assessed when tours are
canceled by EXOTICATRAVEL.

BAGGAGE: The passenger is allowed to bring one (1) checked bag which may have a maximum weight of 70 lbs. and maximum combined
dimensions of 62 inches. Also, one (1) cary-on with maximum dimensions of 8" x 12" x 20" is permitted. Luggage is the passenger s
responsibility and that of the airlines. For lost luggage claims, the passenger is responsible for notifying the airline directly.

SEAT ASSIGNMENT: There is no advance seat selection for tour departures. Early check-in is necessary to secure seats with travel
companion. Three hours advance arrival to departing airport is necessary.

RESPONSIBILITY AND LIABILITY: for Flight and Passenger Accommodations and Services: EXOTICA TRAVEL (herein referred to as the
ET) is responsible for making all arrangements for tour services offered in the brochure. The airlines, hotels, land operators, and other
suppliers providing services are independent contractors and not agents, employees, or associates of the ET. Promoters and not agents,
employees or authorized representatives of ET. Acceptance and confirmation of your reservation is at the discretion of the airlines even after
full payment has been made. ET assumes no responsibility or liability in connection with the service of an aircraft, motor coach, taxi, or other
conveyance which may be used in the performance of its duty to the passengers. All vouchers and other documents for services issued by
the ET are subject to the terms and conditions specified by the suppliers and to the laws of the country where services are supplied. If the
tour services as indicated by the brochure cannot be supplied or there are changes in the itinerary for reasons beyond the control of the ET,
we will arrange for provisions of comparable services. Any resulting additional expense will be payable by the passenger participant. The ET
reserves the right to decline or accept or retain any person as a passenger, to make changes in the itinerary whenever the ET deems it
necessary to the comfort, convenience and safety of the passengers, and to cancel a tour at any time. A minimum number of passengers
(unless otherwise noted) is required or the tour is subject to cancellation. If the ET cancels a tour, it shall have no responsibility beyond the
refund of all monies paid to the ET by the passenger participant. The passenger agrees that the ET shall not be liable for any changes in flight
schedules, delays, weather conditions, damages, losses (including personal injuries, deaths, and property losses) or expenses occasioned
by acts or omissions of any person, including suppliers providing services, or for any acts of war, insurrection, revolts or other civil uprisings,
military actions, strikes or acts of God occurring in either the country of origin, through passage, or destination. No person other than an
authorized representative of the ET by written document is authorized to vary , add, or waive any term or condition in this brochure, including
the terms and conditions set forth in the forgoing provisions.
All published fares and prices are based on exchange rates and all fares and prices quoted at the time of publication are subject to change at
any time.

PASSPORTS AND VISAS: ALL PASSENGERS MUST HAVE A VALID PASSPORT. Passports should be in your possession before a
reservation is made. Some countries require Visas. ET assumes no liability for Passport or Visa procurement. Foreign nationals must have a
valid Passport and Alien Registration Card. Foreign nationals must also check with the Embassies of their respective countries as to USA
requirements and with The Internal Revenue Service for any tax liability.

NOTE: The sequence of activities in the itinerary may change or be reversed but none will be omitted except for circumstances beyond our

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