PAC Tour REGISTRATION FORM 2020 Complete and Mail to: PAC Tour, PO Box 303, Sharon, WI 53585 Please fill in registration form and return (This is your Health Form) You can BOLD the text to indicate your choice. Be sure to enclose/attach a photocopy or scanned copy of your medical insurance card, both sides please! First Name Last Name Address City State Zip Home Phone Mobile Phone Email Occupation Sex Male Female Age Birth Date Birthplace Hair color Eye Color Height Weight MEDICAL- List two people to contact in case of an emergency Name Phone Relationship Name Phone Relationship Name of personal doctor Phone Name of Health Insurance Policy # List any physical disorders in case of an emergency: Allergies to Food, Medicine or other items Names of prescription medications currently taking Date of most recent Tetanus shot (Recommended every 5-7 years.) NEW Since 2019! If you have a snoring issue – you must bring a compatible roommate as a single room may not be available for all tours. I do not have a snoring problem and if I register in a shared room and it is determined that my roommate cannot sleep due to my snoring – I agree to pay a single supplement for my roommate and myself for the remainder of the tour. (2 times the single supplement) PAC Tour will make a reasonable effort to help resolve the snoring roommate issue when possible. Initial here
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PAC Tour REGISTRATION FORM 2020
Complete and Mail to: PAC Tour, PO Box 303, Sharon, WI 53585
Please fill in registration form and return (This is your Health Form) You can BOLD the text to indicate your choice.
Be sure to enclose/attach a photocopy or scanned copy of your medical insurance card, both sides please!
First Name Last Name
Address City State Zip
Home Phone Mobile Phone
Email
Occupation Sex Male Female
Age Birth Date Birthplace Hair color
Eye Color Height Weight
MEDICAL- List two people to contact in case of an emergency
Name Phone Relationship
Name Phone Relationship
Name of personal doctor Phone
Name of Health Insurance Policy #
List any physical disorders in case of an emergency:
Allergies to Food, Medicine or other items
Names of prescription medications currently taking
Date of most recent Tetanus shot (Recommended every 5-7 years.)
NEW Since 2019! If you have a snoring issue – you must bring a compatible roommate as a single room may not be available for all tours.
I do not have a snoring problem and if I register in a shared room and it is determined that my roommate cannot sleep due to my snoring – I agree to pay a single supplement for my roommate and myself for the remainder of the tour. (2 times the single supplement) PAC Tour will make a reasonable effort to help resolve the snoring roommate issue when possible.
Initial here
I am registering for: Form should be fillable but You can BOLD the TEXT to indicate your choice.
Jersey Vest (Vests are always sleeveless) Jacket (Jackets are Long Sleeve)
Men’s Style OR Women’s Style
Extra Small Small Medium Large Extra Large
Sleeve Style: Sleeveless Short Sleeve Long Sleeve
Jersey Cut: by bolding or circling the word - RACE CUT (narrow) or CLUB CUT (wider)
T-Shirt Size: Men OR Women
Extra Small Small Medium Large Extra Large
Sweatshirt: Additional $30 Men’s or Women’s Extra Small Small Medium Large Extra Large
To register: Complete these forms mail them with your deposit check. Deposits must be made by check.
Please email [email protected] to alert her that you are registering by mail. You will then need to print, sign and mail the Payment/Cancellation and Liability form to the office.
Make a copy for your records, noting the dates for payments and all policies.
Payment Schedule/Cancellation Info: Include your non-refundable deposit amount with this form to make your reservation. Final payment amount is based on the number of registered riders on Jan. 1st, 2020. Final payment dates are listed above for each tour.
Before you sign up we recommend you consider trip cancellation insurance to protect your deposit in the event you are unable to attend, the tour is interrupted, or you are forced to leave the tour early. This insurance policy could be your refund if you need to cancel – provided you purchased the correct policy.
• Riders are responsible for obtaining travel insurance to cover their costs in case of road closure by forest fire or other disasters. This is called trip interruption insurance.
• Riders requesting a roommate will be required to pay the single supplement amount (nonrefundable) 120 days before their tour to cover room costs should they cancel and a replacement rider does not register.
• Final payments are due ~80 days before fly in of the tour or January 15th for all Desert Camp Weeks.
• No refunds for Desert Camp or Peru cancellation after final payments have been made.
• All other Tours Refund Policy: A 25% refund if cancellation occurs after final payments have been made.
• No refunds if canceling within 29 days of tour start date.
• A late fee of $100 will be assessed after 10 days – should a rider fail to make the final payment on time.
• There will be another policy page specific to Route 66.
Tour prices are based on double occupancy hotels each night. Note previous snoring policy. You may pay an additional amount if a single room is available. PAC Tour cannot guarantee finding everyone a roommate. Should you be the final person to register for a tour and wish double occupancyand a roommate is not available, you will be asked to pay the single supplement if you wish to register. If a roommate becomes available, you will berefunded the unused portion of the single supplement. During a tour if your roommate goes home, you will be paired with a new roommate. If you need to stay in a single room, you must pay the single supplement for the remainder of the tour.
Riders are responsible for extra costs due to tour changes caused by acts of God, fire or other emergencies.
A PAC Tour gear bag is supplied and must be used to standardize truck loading. PAC Tour gear bags are not supplied for Desert Camp or Peru Tours.
I understand the cancellation, refund and policies of PAC Tour as stated in this registration.
My deposit of $500 for Desert Camp or $1000 for all other tours check is enclosed.
Please mail in this signed application with your deposit check to finalize the registration process.
PAC Tour, PO Box 303, Sharon, WI 53585 262-736-2453 (office)
I acknowledge that this athletic event is an extreme test of a person’s physical and mental limits and carries with it the potential for death, serious injury and property loss.
The risks include but are not limited to, those caused by terrain, facilities, temperature, weather, conditions of athletes, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and eventmonitors, and or producers of the event, and lack of hydration. These risks are not only inherent to athletics, but are also present for volunteers.
I hereby assume all of the risks of participating and or volunteering in this event. I realize that liability may arise from negligence or carelessness on the part of the person or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them or because of their possible liability without fault.
I certify that I am physically fit, have sufficiently trainedfor participation in the event and have not been advised otherwise by a qualified medical person.
I acknowledge that this Accident Waiver and Release of Liability (AWRL) form will be used by the event holders, sponsors and organizers, in which I may participate and that will govern my actions and responsibilities at said events.
In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:
(A) Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me or my traveling to andfrom this event, and the Following Entities or Persons;
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