Chinese Culture Center
Cultural Study Tours in China
Travel Application and Agreement
(803) 252-9086
First Name: ____________ Last Name: ________________ Middle Name: _________________
Home Address:__________________________________________________________________
Home Phone: ________________ Work Phone: ______________ Cell Phone: ______________
Email: ________________________________________________________________________
Age: _______ Gender: Female Male Race: ____________________
Departure City: ______________________ Return City: __________________________
Emergency Contact Name: ____________________ Phone: _____________________________
Relationship to you: _____________________________________________________________
Please enclose your payment of the total tour fare (at least 100 days before your departure date)
payable to the Chinese Culture Center (double occupancy with ___________): $ _____________
Single Occupancy Supplement: $ _________________ Seasonal Surcharge: $ _____________
Payment Date: ___________ Departure Date: ___________ Passport No. __________________
Passport Expiration Date: __________________ Name of Group Leader: __________________
Where did you hear about this Program: State newspaper Gamecock Free Times
Friend: ____________ International Festival E-Mail Other:_______________________
Why are you interested in the cultural tour:
I, the undersigned, understand that I will participate in the Cultural Tours in China Program at my
own risk. I agree to release, discharge and hold harmless the Chinese Culture Center, the travel
agencies, and their respective subsidiaries, affiliates, officers, directors and employees, from any
and all claims or damages arising out of, in any way, my participation in the Program. I also give
consent to the Chinese Culture Center to use my name, photos, comments, videos and any other
forms of media to promote and publicize the Program. The Chinese Culture Center reserves the
right to review the Program and to make changes at any time. I understand that no refund will be
issued after the application deadline, which is 100 days before the departure date.
Participant’s Signature: _________________________ Date: _________________
Please mail the signed Application to Chinese Culture Center, 1708 Greene Street, Columbia, SC 29201