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In order to apply for a trip, every individual must fill out
a separate application form. You can either print out the form
from download
form
and mail it to us or you can use the online form below. Your
place on the requested trip will be reserved 1) for 7 days following
your application receipt or 2) until receipt of the $400 deposit,
whichever comes first. (deposits should be made out and
sent to the address below.
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Trip
Application
Earthbound
Expeditions, Booking Office 5427 Palmyra Road, Pittsford, NY 14534
(716) 317-4969
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Please
fill in all the information
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Name
of Trip
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Date
of Departure
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Your
Full Name (as it appears on your passport)
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Mailing
Address
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City
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State
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Zip
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Fax
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Home
Phone
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Office
Phone
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email
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Occupation
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Marital
Status
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Sex
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Age
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Height
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Weight
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Citizenship
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Date
of Issue
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Place
of Issue
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Passport
Number
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Birthplace
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Birthdate
(Month/Day/Year)
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Have
you been on previous Earthbound Expeditions trips?
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Yes
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No
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Which
ones? (include year)
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I
am willing to share a double room
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Nonsmoker
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Smoker
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I
prefer a single room at supplemental cost
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Dietary
Restrictions
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Relation
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In
Case of Emergency please notify:
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Telephone
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Address
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Earthbound
Expeditions will make all domestic air travel arrangements in
the trip country according to the trip itinerary.
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Seating
Preference
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How
did you find out about Earthbound Expeditions?
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Please
describe your health and extent of your camping, hiking, or
other outdoor experience
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Release
of Liability and Assumption of All Risks
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PLEASE
READ CAREFULLY: THIS IS A LEGALLY ENFORCEABLE WAIVER OF RIGHTS.
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ASSUMPTION
OF RISKS
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,
acknowledge that I have voluntarily applied to participate in
the trip
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I,
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designated
on this application (or a trip which I may subsequently transfer
to). I am voluntarily participating in the tour or expedition
with knowledge that travel to the foreign countries and/or remote
areas visited by this trip involves numerous risks and dangers
including, but not limited to: the forces of nature; civil unrest;
terrorism; roads, trails, hotels, vehicles, boats, or other
means of conveyance that are not operated or maintained to standards
common in the United States; high altitude; accident or illness
without access to means of rapid evacuation or availability
of medical supplies; the adequacy of medical attention once
provided; physical exertion for which I am not prepared; consumption
of alcoholic beverages; or negligence (but not willful or fraudulent
conduct) on the part of Earthbound Expeditions, Inc., or others.
I acknowledge that the enjoyment and excitement of adventure
travel is de rived in part from the inherent risks incurred
by travel and activity beyond the accepted safety of life at
home or work and that these inherent risks contribute to such
enjoyment and excitement, being a reason for my voluntary participation.
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I
HEREBY AGREE TO BE RESPONSIBLE FOR MY OWN WELFARE, AND ACCEPT
ANY AND ALL RISKS OF DELAY, UNANTICIPATED EVENTS, ILLNESS, INJURY,
EMOTIONAL TRAUMA OR DEATH AND VERIFY THIS STATEMENT BY MY SUBMISSION
OF THE ABOVE APPLICATION.
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I
acknowledge that the cost of all Earthbound Expeditions trips
has been based upon Trip Participants executing this Release
of Liability and Assumption of All Risks. Therefore, as
lawful consideration for being permitted to participate on such
trip(s), I hereby
RELEASE AND DISCHARGE Earthbound Expeditions, INC. AND ITS AGENTS
AND EMPLOYEES FROM AND AGAINST ANY AND ALL LIABILITY ARISING
FROM MY PARTICIPATION IN THE TOUR OR EXPEDITION.
I agree this release shall be legally binding upon myself, all
minors under the age of 21 traveling with me, my heirs, successors,
assigns, and legal representatives; it being my intention to
fully assume all the risk of travel and to release Earthbound
Expeditions, Inc. from any and all liabilities to the maximum
extent permitted by law.
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I
understand that all applications are subject to acceptance by
Earthbound Expeditions and upon acceptance shall be deemed to
have been entered into and to be performed in Tucson, New York.
In the unlikely event a legal dispute should arise involving
any subject matter whatsoever, I agree that the following conditions
will apply: (a) the dispute shall be settled by binding arbitration
through the American Arbitration Association in Tucson, New
York; (b) the dispute will be governed by New York law; and
(c) the maximum amount of recovery to which I will be entitled
under any and all circumstances will be the land cost of my
trip with Earthbound Expeditions.
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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 effetc.
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KNOWING
AND VOLUNTARY EXECUTION I
have carefully read and fully understand the contents and legal
ramifications of this agreement as well as all the conditions
as stated under the heading Terms
and Conditions
of this site, especially noting those regarding cancellation
and refund policies, limitation of liability, and responsibility
borne by trip participants. I understand this is a legally binding
and enforceable contract and sign it of my own free will.
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In
submitting this application, I and agreeing to all the statements
in the Release of Liability and Terms and Conditions sections
of this site. I also am attesting to the truthfullness of
all the information which I have provided on this form.
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