ALL REGISTRATION IS AVAILABLE ONLINE FROM EACH TRIPS INFO PAGE.

HOWEVER, IF YOU PREFER TO MAKE A RESERVATION OFFLINE, YOU MAY PRINT THIS FORM AND MAIL IT IN.  PLEASE CALL 1-877-900-7022 WITH ANY QUESTIONS.

DO NOT BOOK ANY AIRFARE UNTIL APPLICATION HAS BEEN ACCEPTED AND YOU'VE BEEN INSTRUCTED TO DO SO.

Print This Page, Complete All Information And Mail The Signed Application Along With Your Payment To:

Just Singles Adventures - GR Dept, 42 Overton Ave, Milford, CT 06460-6335

If you have any questions regarding your registration, please call us at 1-877-900-7022

Requested Event:_________________________________________  Reference:_____________________

Name:________________________________________________  M/F  Birthday:____________________

Address:  ___________________________________  Address:__________________________________

City/State/Zip:___________________________________________________________________________

Home Phone:_________________________________  Work Phone:______________________________

Cell Phone:________________________  Email:______________________________________________

Name, Number and Expiration AS IT APPEARS on your PASSPORT

_______________________________________________________________

Medical Info We Should Know About:________________________________________________________

_______________________________________________________________________________________

Emergency Contacts:_____________________________________________________________________

_______________________________________________________________________________________

Roommate Preference:____________________________________________________________________

CANCELLATION/LIABILITY WAIVER/TERMS&CONDITIONS:

Cancellation Policy: No refunds will be issued for cancellations made 65 days or less prior to any event. Any cancellation made between 90 days to 65 days before a trip will qualify for a 60% refund. Cancellations made beyond 91 days will qualify for a full refund less a $75 administrative fee. If final payment is not paid by the due date, your reservation will be cancelled and all fees will be enforced.

Charges For Air Ticket Changes:

I understand that charges for either ticket name changes and/or changes in the itinerary after ticketing vary with airline and are my sole responsibility.

Travel Insurance:

I understand that trip insurance is available and have made appropriate arrangements.

Responsibility Notice: The trip/vacation/event advertised herein, including all tickets, vouchers and coupons issued and all arrangements for transportation or conveyance or for hotel or lodging or for sightseeing services are made by Just Singles Adventures (JSA) and/or its officers, affiliates and sponsors, as agency and/or service providers and/or suppliers providing services necessary for operation of the tour/travel/event upon the express condition that JSA and/or its officers, affiliates and sponsors shall not be liable for any injury, damage, loss, accident, delay or irregularity to any event participant or his/her property that may result from any act or omission of any company, contractor or employee thereof providing services in connection with the event, including but not limited to transportation, lodging, food and beverage, entertainment, sightseeing, luggage handling and tour guiding. Furthermore, JSA and/or its officers, affiliates and sponsors cannot be held responsible for delays resulting from weather and road connections, breakdowns, strikes, riots, acts of G-d, authority of law or other circumstances beyond its control. In the event that those participants who have made full or partial payment for the tour will be entitled to a full refund of monies paid, under no circumstances will JSA and/or its officers, affiliates and sponsors be liable for cancellation to a tour participant in excess of amount paid. JSA and/or its officers, affiliates and sponsors reserve the right to decline or retain any persons as an event participant at any time. JSA and/or its officers, affiliates and sponsors are not responsible for price increases imposed by the event coordinators/tour operators and/or service providers. JSA and/or its officers, affiliates and sponsors are not responsible for breach of contract or any intentional or careless actions or omissions on the part of the event coordinators/tour operators and/or service providers, such as suppliers of tours or other services used or obtained on or at the time of the event, trip or program, which result in any loss, damage, delay or injury to you or your travel companions or group participants. There is no guarantee any of such suppliers rates, booking or reservations and JSA and/or its officers, affiliates and sponsors shall not be responsible for any social or labor unrest, mechanical or construction difficulties, diseases, local laws, climate conditions, abnormal conditions or developments or any other actions, omissions or conditions outside JSA and/or its officers, affiliates and sponsors control. The above people and organizations may use photographs taken during this trip/vacation/event for publications on their web sites and/or in print advertising. By embarking upon his/her travel/vacation/event, the traveler/participant voluntarily assumes all risks both monetary and physical, and is advised to obtain appropriate insurance coverage. Retention of tickets, reservations, or package after issuance shall constitute consent to the above and an agreement on your part to convey the contents hereof to your travel companions.

Signature:_______________________________________  Date:______________

NOTE: Your signature here verifies your complete understanding and acceptance of the Responsibility Notice above.  If you have any questions or concerns about this notice, DO NOT sign this form until you have contacted us .

Please enclose payment and a copy of your passport with this registration and note all payment deadlines.

If you have any questions regarding your registration, please call us at 1-877-900-7022

PAYMENT INFORMATION

Event Price:_____________________________  Description:_____________________________________

Add On 1:_______________________________  Description:_____________________________________

Add On 2:_______________________________  Description:_____________________________________

Other Amt:______________________________  Description:_____________________________________

TOTAL DUE: $_________________________________

Amount Enclosed: $_________________________________ Payment by: Check/Credit Card

Please make check payable to: Just Singles Adventures

CREDIT CARD AUTHORIZATION

Authorized Amount to Charge: $____________________________________________________________

Credit Card Type:_______________________________  Exp Date:____________  Security#:__________

Credit Card #:___________________________________________________________________________

Name as it appears on card:_______________________________________________________________

Billing Address and Phone Number of Card Holder

Address:  ___________________________________  Address:___________________________________

City/State/Zip:___________________________________________________________________________

Phone1:____________________________________  Phone2:____________________________________

I authorize Ross Gordon, TYGA Marketing and/or it’s authorized affiliate(s) to charge my credit card as detailed above.

Card Holder Signature:_______________________________________________  Date:_____________

Please enclose payment and a copy of your passport with this registration and note all payment deadlines.

RESERVATIONS WILL ONLY BE CONSDERED COMPLETE AFTER DISCLAIMER IS SIGNED AND RECEIVED.

If you have any questions regarding your registration, please call us at 1-877-900-7022

Special Requests: