Cuba Educational Programs
Program Name --Select One-- Pinar del Rio El Corazon de Cuba La Cuna del Espiritu Cubano and Date Name (official) Nickname Nationality Passport # Exp. date Gender: FMX Age Height Weight Birthday Place of Birth Occupation Address1 Address2 City State/Prov Zip/Postal Code Country Tel. Day Tel. Evening Best hour to receive telephone calls --Select One-- Morning Afternoon EveningAnytime E-mail In Case Of Emergency Notify: Name Relationship Tel Address Acceptance Of General Terms And Conditions: I have read and understand the document, "GENERAL TERMS AND CONDITIONS". I accept and agree to be bound by the "GENERAL TERMS AND CONDITIONS". Yes No Understanding Of Legal Contract: I have read and understand that the agreement entitled "VOLUNTARY WAIVER AND RELEASE FROM LIABILITY AND INDEMNITY AGREEMENT" is a LEGAL CONTRACT. I have read each paragraph very carefully and made certain that I fully understand what the paragraph says. If I do not fully understand, or do not fully agree to the terms I WILL NOT INDICATE THAT I DO. I understand that I can go elsewhere to bicycle and travel if I do not agree to these terms. I have not been forced in any way to agree to this document, and am doing so because I am willing to accept all risk associated with bicycling and traveling in order to participate on Ibike’s program. Yes No Rooming Preference: Rooms are generally, but not always, double occupancy -- we encounter a variety of lodging conditions that aren't able to accommodate all desires. If you are not registering with a roommate, if you wish, we will try to match people with roommates, but a roommate cannot be guaranteed. If you; want a "twin shared room" that is not available, don't have a roommate, or don't want a roommate there may be a single supplement charge. This represents the actually difference in the cost to the program. Similarly there may be situations where single occupancy cannot be guaranteed. To facilitate planning, please let us know your rooming preference. Rooming Preference: --Select One-- Double Occupancy - Double Bed Double Occupancy - Two Twin Beds Double Occupancy - Twin shared (try to find me a roommate) Single Occupancy (I'll pay the single supplement) Name of roommate (if relevant)
My bicycling experience:
My international travel experience:
My current level of physical activity:
Special interests: I would especially like to see or learn about.... (e.g. art, social justice, apiary, etc)
Dietary restrictions, allergies, special medications or other personal needs:
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