Docstoc

Tests

Document Sample
Tests Powered By Docstoc
					                                                                                    field to plate
Spring 2007 International Exchange Forum
Registration Form                                                                                                                  ®




Children, Obesity, Food Choice and the Environment:                                     Innovation. Inspiration. Food Education.
Helping children make healthful food and lifestyle choices
in the school, home and community environment
With a Special Focus on School Lunch and
Nutrition Education in France

Perspectives from the USA and France

      April 22-27, 2007
      Loire Valley & the Vendee, France

 Forum Pricing                                                  Weekend of Food and Art in Paris

 Full Conference Program - all session and tours                We have made arrangements with leading food and art
                                                  SPECIAL       experts in Paris to book food and art tours on your behalf.
                                                EXTENS          Please indicate on the registration form if you are interested
 Early Bird - $2450                                    ION
                                                                in spending the weekend in Paris following the professional
 Deposit must be received on or before 01/15/07
                                                                program. Optional events are listed at the botton of the
           > Early Bird Deposit - $700                          schedule. We leave you to decide on where you would like
           > Balance due 02/15/07 - $1750                       to stay and eat in Paris, although we can help you out. We
                                                                simply provide the tour options and make the
 Regular Pricing (after 01/15/07) - $2750                       arrangements.
       > Depost - $700
       > Balance due 02/15/07 - $2050                           Price is “land only,“ per person, double person occupany.
                                                                Includes: All didactic sessions, visits, tours, guided tours and
 Single Supplement - $400                                       tastings, 5 overnights in luxury accommodations, 5 breakfasts,
                                                                5 lunches (including school lunches)*, 4 dinners with wines,
                                                                welcome coffee and aperitif, refreshment breaks, in-country
 Student Price - Contact Us                                     transfers from designated arrival and departure points.
 Guest/Spouse - $2250                                           Excluded: Air/ground travel to and from designated meeting
 Includes same amenities as the full conference program         and departure points in France, and expenses of a purely
                                                                personal nature.
 with the following substitutions:
   • Tuesday: Full day of touring in the Loire per              Arrival Meeting Point: Tours – 1 hour by train south of Paris by
                                                                fast, easy train connection.
     conference package
   • Thursday: Full day of touring in the Vendee or             Departure Point: Nantes – 2 – 2.5 hours west of Paris by fast,
     Brittany (lunch not included)                              easy train connection.
   • Optional day in Tours on Monday                            *Lunch not included on Tuesday/Thursday for companion
     (lunch not included)                                       package


Notes
Once we have received your deposit, you will begin to receive communications
from us about making preliminary travel arrangements.

When we receive your final payment, you will receive complete information about:
  •    Suggested travel arrangements to and from France, and within France
  •    Arrival and departure points
  •    Optional lodging recommendations prior to and after the conference
  •    Information about weather, clothing recommendations, personal safety, currency
  •    Options in Paris
  •    Things to do in France before and after this continuing education program

We are available to assist you with transportation recommendations for travel to and within France.
Spring 2007 International Exchange Forum Registration Form

 Registration Options:

 •       Call 301.865.4607 or toll-free 888.556.4706 to register via telephone. Please have your credit card info ready.
 •       Fax completed registration form with credit card info to Field to Plate at 301.542.0027
 •       Mail completed registration form with credit card information or check made payable to Field to Plate,
         6712 W. Lakeridge Rd., New Market MD 21774

 Your Contact Information:
     Name .................................................................................................................................................................

     Address ...............................................................................................................................................................

     City ......................................................................................... State ................... Zip ........................................

     Phone..................................................................................................................................................................

     Email ...................................................................................................................................................................


     Select Package You are Registering for:

     (     ) Early Bird Deposit (by 01/15/07) = $700                                                            (     ) Single Supplement = $400
     (     ) Early Bird Balance Payment (due 02/15/07) = $1750                                                  (     ) Student = Contact Us
                                                                                                                (     ) Guest/Spouse Full Payment = $2250
     (     ) Regular Price Deposit (after 01/15/07) = $700
     (     ) Regular Price Balance Payment (due 02/15/07) = $2050                                               (     ) Weekend of Food and Art in Paris


     I am a (check one):               (    ) RD        (     ) DTR         (    ) Student           (    ) Other ............................................................
     TERMS OF PAYMENT:

     All payments are due in full by February 15, 2007. All registrations afterwards must be paid in full at time of registering.

     ___ Check enclosed* (Payable to Field to Plate)                                                  ___ Send me a receipt for my records
     ___ Please charge my ( ) Visa ( ) Mastercard

     Card Number...................................................................................................... Expiration .........................................

     Name on Card ..............................................................................................................................................................

     Signature ......................................................................................................................................................................
     (By signing, you acknowledge that your credit card will be charged for the amount indicated above.)

*Cancellation Policy: All cancellations must be received in writing (via mail or fax) and will be processed on the day received. A $300
administrative fee will be assessed for all refunds processed prior to January 1, 2007. Refunds will be issued according to the following
timeline: Prior to January 1, 2007—Program will be refunded in full, except for a $300 administrative fee. January - March 15, 2007—
50% of the Program cost will be refunded. After March 15, 2007—No refunds will be issued. “No shows” for any reason are subject
to the full fee. No exceptions can be made to this cancellation policy. Additional details about registration and cancellation policy viewable
at www.fieldtoplate.com/france_policy.php.

Amanda Archibald, RD is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR).

                    Field to Plate 6712 W. Lakeridge Rd., New Market MD 21774 • 301.865.4607 • 301.542.0027 fax
                                                      www.fieldtoplate.com • info@fieldtoplate.com
TERMS AND C ONDITIONS

Field to Plate®, its employees, subsidiaries, affiliates, officers, directors, does not own or
operate any entity which is to provide goods or services for your trip (including, for
example, lodging facilities, transportation companies, food service providers, equipment
suppliers, etc.) As a result, Field to Plate is not liable for any negligent or willful act or
failure to act of any such third person, or of any other third party.

In addition, I acknowledge that I have voluntarily applied to participate in the trip
designated on this application. I am voluntarily participating in this trip with the
knowledge of the numerous risks and dangers involved including but not limited to:
negligence in any manner on the part of Field to Plate including, without limitation,
negligence in the conduct or arrangement of the trip in any respect from inception to
completion, negligence with regard to the maintenance or operation of any bus or other
motor vehicle utilized to transport passengers, etc.; physical exertion for which I am not
prepared; forces of nature; transportation failures whether by plane, train, auto, by foot,
or by any other conveyance; consumption of alcoholic beverages; risks associated with
food or impure water; civil unrest; terrorism; criminal activity; dangers associated with
wild or other animals; accident or illness without access to means of rapid evacuation or
availability of medical supplies or services; the adequacy of medical attention once
provided; and stolen, lost, or misplaced luggage or property. I HEREBY AGREE TO BE
RESPONSIBLE FOR MY OWN WELFARE AND ACCEPT ANY AND ALL RISKS
OF DELAY, UNANTICIPATED EVENTS, INCONVENIENCE, ILLNESS, INJURY,
EMOTIONAL TRAUMA OR DEATH.

I acknowledge that the cost of this Field to Plate conference in Challans, France and the
Loire Valley is based upon trip participants executing this Release of Liability and
Assumption of All Risk Agreement. Therefore, as lawful consideration for being
permitted to participate on such trip(s), I hereby RELEASE AND DISCHARGE
FOREVER Field to Plate FROM AND AGAINST ANY AND ALL LIABILITY
ARISING FROM MY PARTICIPATION IN THE TRIP. I agree that this release shall be
legally binding upon me personally, all members of my family and all minors traveling
with me, my and their heirs, successors, assigns, and legal representatives, it being my
intention fully to assume all the risks associated with this trip and to release Field to Plate from
any and all liabilities to the maximum extent permitted by law. I agree that Field to Plate
reserves the right to make conference, hotel and trip modifications as required or desirable to
improve the trip quality and/or to accommodate the comfort and well-being of guests.

KNOWING AND VOLUNTARY EXECUTION: I have carefully read and fully
understand the contents and legal ramifications of this Agreement as well as all
statements regarding cancellation and refund policies. I understand that this is a legally
binding and enforceable contract and sign it of my own free will. I agree that if any
portion of this agreement is found to be void or unenforceable, the remaining portions
shall remain in full force and effect.

Signature: ________________________________ Date: ________________

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:24
posted:7/18/2011
language:English
pages:3