For any additional information or questions contact Lenny Gemski 904 471 5369, lgemski@earthlink.net.
Address_______________________________
City__________________________________
State Zip Phone________________________
Email________________________________
Emergency contact_____________________
TOTAL AMOUNT ENCLOSED $_______
Please assign me a roommate --yes or no
I wish to be a roommate with_________________________
Balance: The balance of your trip is due
January 20, 2011, 90
days prior to departure. May be paid by check or money order, in US dollars.
Make out
to Domaine du Haut
Baran and send balance to Lenny Gemski 22 Sea Oaks Dr, St
Augustine FL 32080.
For reservation information please call Lenny Gemski 904 471 5369. lgemski@earthlink.net
Trip Painting in South of France with Lenny
Gemski Departure
date____________Trip cost $2900
Name__________________________ (M F) Name____________________________
(M F)
Address ________________________Address__________________________________
City State Zip____________________ City State Zip________________________
Country_________Phone___________Country___________ Phone____________
Passport No____________________ _Passport No.______________________
Email___________________________ Email____________________________
Emergency contact_________________ Emergency contact______________________
Accommodations : If you are a couple, would you prefer a
room with 2 beds or 1 large bed?
All single guests will share a room with twin beds. If you want your
own room the single supplement is 1000 US
Deposits : $ 500.00 USD per person. Deposits can be paid by
personal check or money order , payable to Domaine du Haut Baran and mailed
to :Lenny Gemski
22 Sea Oaks Dr, St Augustine, FL 32080 All Deposits are non-refundable.
Balance : The balance of your trip is due 90 days prior to departure
and may be paid by check or money order in dollars USD.If the final payment
is not received
when due, we reserve the right to cancel the reservation per our cancellation
policy .Prices are in USD. Prices cover land costs only , not airfare.
Price per person is based on 10 or more participants.
Cancellation/Refund : Cancellation fees are determined accordingly
: 91 days prior to trip, 500.00 USD
61-90 days prior to trip, 50% trip price : 31-60 days prior to trip,
75% trip price : 0-30 days prior to trip, no refund. Exceptions cannot
be made
for any
reason and there is no refund for arriving late or leaving a trip early.
If we must cancel a trip, all payments received to date will be refunded
and this constitutes
full settlement. We are not responsible for expenses incurred in preparation
for any trips ( even cancelled trips ) , such as airline tickets, travel
delays, flight cancellations or health problems. This tour will be held
regardless of
world events.
Travel insurance is highly recommended, and should be arranged
by you within 10 days of making deposit.
Responsibility Clause : Domaine du Haut Baran (DDHB),
Lenny Gemski, employees,affiliates,successors,or assigns is not liable
for any negligent
or willful act or failure to
act,of any person,third party or entity which is to,or provides goods
or services
including
but not limited to:transportation companies,equipment suppliers,food
service providers ect,, I acknowledge that I am voluntarily participating
in this
trip with the knowledge of the inherent risks and dangers invovled,including
but not
limited to:negligence on the part of DDHB,its employees,physical exertion,forces
of nature,transportation failures,consumption of alcohol,risks with food
or impure water,civil unrest,terrorism,criminal activity,wild or other
animals,failure of equipment,accident or illness without means of evac,or
availability of
medical
supplies or services or adequacy of medical attent once provided,and
lost/stolen/or misplaced luggage or property.I hereby agree to be responsible
for my own
welfare and accept any and all risks of delay,unanticipated events,inconvenience,illness,injury,emotional
trauma or death.I hereby release and discharge forever DDHB,and employees,
from
and against any and all liability arising from my participation in this
trip.I agree that this release is legally binding upon me,all members
of my family
and all minors traveling with me,my and their hiers,successors,assigns,and
legal
representatives, it being my intention to release DDHB and employees,successors,affiliates,and
assigns from any and all liability to the maximum extent by law.I acknowledge
that to participate,I will require a legal passport,and that DDHB reserves
the right to remove me or any participant it judges incapable of meeting
the rigors
of activities or who detracts from the enjoyment of the trip by others.I will follow all safety rules presented to me either written or oral by
Domaine du
Haut Baran(DDHB).
______________________________________________________
signature
______________________________________________________
signature