Encore Tours

Registration Form

Music Travel and Music Educator Resources

Issue link: http://resources.encoretours.com/i/690876

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Encore Tours Registration Form Please use blue or black ink, print in CAPITAL LETTERS and fill in circles completely (ex: ). Do not staple anything to this form. Please return this form to: Encore Tours, 343 Congress Street, Suite 3100, Boston, MA 02210 Office Use Only I have read the attached Encore Tours Terms and Conditions and the Encore Tours Release and agree to be bound thereby, and agree to be responsible for all amounts owed Encore Tours. I am in good physical and mental health and am able to travel without special medical supervision or special counseling. Signature of Registrant Date All registrants under 21 years of age must have the following section completed: I am the parent/legal guardian of the above minor registrant. I have read the Encore Tours Terms and Conditions and the Encore Tours Release, and agree to be bound thereby, and agree to be responsible for all amounts owed Encore Tours by the minor and any other actions by the minor on the Encore Tours trip. I hereby consent to the above minor registrant's participation in all activities organized and/or provided by Encore Tours. I hereby assume all risks of loss and injury that may be incurred, directly or indirectly, as a result of any such participation and authorize Encore Tours to arrange for professional care/treatment in case of an emergency. Signature of Parent or Guardian Print Name Date Protection Plans: Please see page 3 or www.encoretours.com/resources/insurance.cfm for more information. Sign me up for the Ultimate Protection Plan (our most enhanced health, baggage and cancellation coverage). Sign me up for the Comprehensive Protection Plan (our enhanced health, baggage and cancellation coverage). I decline additional coverage at this time. I will book my own round-trip air transportation. (I will meet the group at the first hotel.) I would like to extend my stay after the trip. (A form will be sent to you about alternate returns. Western Europe only.) I am over 24 and wish to pay a surcharge for a single room (where available). I would like Encore Tours to book me from a DIFFERENT U.S. departure city than that of my group: with: and double twin triple Gender: M F First Name Middle Name Zip State Date of Birth MM/DD/YYYY / / Group Leader's Last Name Program Selection Group # Departure Date / / MM/DD/YYYY Rooming and Additional Options: Please fill in all that apply. Personal Information Parent/Emergency Contact Info: Required for all participants. Last Name (Print all of your names exactly as they appear on your passport.) Address City Home Telephone Enter to Win Your Tour For Free! Available to all participants enrolled in our Automatic Payments plan. Learn more at www.encoretours.com/autopay Manual Payments I will be responsible for paying my full balance according to the payment schedule on page 6 or the specific schedule set up for my group. Final balance is typically due 90+ days prior to departure. Late fees may apply. Automatic Payments My program balance will be divided into convenient equal monthly installments and deducted from the checking account used for my initial payment up to 45 days prior to departure. Select your preferred Payment Plan: Participant Email I am traveling with a family member and prefer to room in a Payment: Please pay via check or money order made payable to Encore Tours. (Both participants may incur a surcharge to guarantee a twin or double room) Signatures Name Telephone $ . Amount Enclosed Performer Non - Performer Director Parent/Other Email Initial Payment: The greater of $200 or the total balance due as indicated on your group's customized payment plan. (If no selection is made, coverage defaults to the Comprehensive Protection Plan) Please List Instrument or Voice Part 55620

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