sweetwine travel services invites you to new york ......sweetwine travel services invites you to...
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Sweetwine Travel Services Invites You to
NEW YORK STATE & NEW YORK CITY
Sweetwine Travel Services invites you to join us on an 8-night journey as we explore our African American History traveling through
NEW YORK STATE& NEW YORK CITY
October 23-31, 2019
Sweetwine Travel Services CST #2035553-4023110 State Road 54, #402, Lutz, Florida 33549 | PHONE (510) 834-7690 FAX (800) 878-6386 | [email protected]
Includes:
Package Price Per Person* From the Following Departure Cities :
San Francisco (SFO - Albany, NY - JFK - SFO): $2,975
Detroit (DTW - Albany, NY - JFK - DTW): $2,950
Tampa (TPA - Albany, NY - JFK - TPK): $2,900
Atlanta (ATL - Albany, NY - JFK - ATL): $2,510
New York City (NYC - Albany, NY - NYC): $745
• Roundtrip airfare
• Travel insurance
• 2-nights hotel accommodations at the Hampton Inn in Albany
• 6-nights hotel accommodations at the Crown Plaza in Times Square, New York City
• Daily breakfast at New York State hotel ( ONLY)
• Exclusive transportation by private coach bus for New York State tour
• Fully guided professional tour with Jennifer Tosch, founder of Black Heritage Tours
• Additional guides at designated historic sites for New York State tour
• Entry to all museums, historic sites, and attractions
• Guidebook: Dutch New York Histories: Connecting Africans & Native Americans
• Welcome dinner at Umana in Albany
• Orchestra seats to the Broadway play “Ain’t Too Proud: The Life and Times of the Temptations” in NYC
• Orchestra seats at Amateur Night at the world famous Apollo Theatre
• 2 Guided sightseeing tour in Brooklyn and Lower Manhattan
* All rates for the New York State and New York City Tours are based on double occupancy. A non-refundable deposit of $335.00 per person is due by February 12, 2019. The advertised price quotes are based on a minimum of (10) full paying passengers that have completed the required forms. Airfare, air taxes, and fuel charges are subject to change until tickets have been issued. Please read the “Terms and Conditions” section for more travel details and information. Sites selected are subject to change without advance notice.
NEW YORK STATE & NEW YORK CITYITINERARY: OCTOBER 23-31, 2019
Wednesday - Day 1: Depart for Albany, NY
Upon arrival in Albany, NY, we board our private coach bus and check into our hotel (lunch is on your own). After lunch we will visit the Stephen & Harriet Myers Residence, Abolitionists and an official Underground Railroad site, followed by the Ten Broeck Mansion, an 18th century colonial family with Dutch and slavery heritage. Welcome dinner at Umana, a Black owned, West Indian/African Restaurant. After dinner, shuttle will return to the hotel.
Thursday - Day 2
After breakfast (included) at the hotel, we board our private coach and continue the journey through the historic Hudson River Valley visiting sites that may include: Crailo State Historic Site of a Dutch family from Amsterdam that includes a special exhibition, “A Dishonorable Trade” The Broeck Mansion; and Schuyler Flats African Burial Ground. We will take a cruise on the Hudson onboard the Onrust, an exact replica of the first ship built by the Dutch in the 17th century in New York State. We’ll take a drive through Kingston’s Stockade District and a visit to the First Senate House. After the tour through Kingston, we visit the abolitionist’s Sojourner Truth Memorial in Esopus, commemorating her journey towards freedom near her birthplace. We will have free time for shopping in Rhinebeck before returning to the hotel. Dinner is on your own (a list of suggestions will be provided). Optional: After dinner, join your guide to the “Speakeasy” for live jazz.
Friday - Day 3
After breakfast, continue the journey in the Hudson River Valley to NYC. Stop at the Tethford Farm, an 18th century farm in Red Hook, for an amazing presentation with historic indigenous artifacts, objects and clothing, while learning about Native American history of the five nations before Europeans arrived. We may visit the Huguenot State Historic Site, an original Dutch village that includes Native American and African history and a memorial gravesite of an African descendent remains that were found on the site. Experience the Walkway Over the Hudson State Historic Site, Mt. Gulian State Historic Site for a special “White Glove Tour” of the home of the Verplancks, a Dutch family and James F. Brown, the self-emancipated African-American family gardener. After the tour we depart for NYC. The first stop in NYC will be the oldest house built in Manhattan, the Dyckman Farmhouse, in Harlem. Check in to hotel in Manhattan. After check-in, the afternoon is at your leisure to explore the area. Dinner is at a local restaurant (not included in package).
Saturday - Day 4
After breakfast (not included in the package) we will depart the hotel around 10:30am for a day of sight-seeing. Our first stop will be a free tour with the Staten Island ferry. The Staten Island ferry is a popular tourist
attraction which goes back and forth between the Southern tip of Manhattan and Staten Island. The view from the ferry is absolutely spectacular and is the same as you would get on many paid cruises. This is a great way to see the Statute of liberty for free. Our next stop will be the National 9/11 Memorial at Ground Zero and World Trade Center. At Ground Zero, the 9/11 memorial is a great place for quiet reflection. Where the Twin Towers once stood, two pools have been built in their footprints, bearing engraved names of all the victims of the attack. This beautiful tribute to the nearly 3,000 people who lost their lives was named Reflecting Absence by its designers, which fits perfectly with the sense of calm that the National September 11 memorial brings over its visitors. One World trade Center is just a few meters away and, while not for free it provides some of the best views of the city.
Our last sightseeing activity today will be to take a ride on the Roosevelt Island Tramway. I lived on Roosevelt Island for 6 years. The Roosevelt Island Tramway is an aerial tramway that spans the East River. At a height of 80 meters, you can enjoy fantastic views across the East River towards Downtown and Uptown Manhattan. This is a special and often unknown attraction, but definitely worth a visit. Dinner is at a local restaurant (not included in the package).
Sunday - Day 5
After breakfast, I welcome those interested in attending church service with me. We will depart the hotel at 9am to attend the 10:45am service at Christian Cultural Center in Brooklyn, NY. I attended this church during the years I lived in New York. The Pastor is Pastor A.R. Bernard. Christian Cultural Center began in 1978 as a small parish in the Williamsburg section of Brooklyn. Our mission at CCC is to spread the gospel of Jesus Christ, help spiritual seekers become transformed believers, and demonstrate the love and compassion of Christ to the world, through humanitarian works and social engagement. Today Christian Cultural sits on a 11.5 acre campus and has a registered membership of over 37,000. For those who would like to visit other church services, I will provide a list of churches in the Harlem Area. The afternoon is at your leisure.
After church, we will have lunch at a local restaurant in Brooklyn.
Monday - Day 6
After breakfast, we will depart the hotel for a guided walking tour of 2.5 hours through the Borough of Brooklyn. Brooklyn is one of the largest boroughs in the city in area and population. It was formerly an independent city until 1898. It has a population of 2.6 million people and 97 square miles.
Our second guided tour of 2.5 hours will be of the Southern Manhattan SoHo and TriBeca area. SoHo and TriBeca are some of the most famous neighborhoods in Manhattan. After the tours we will return to our hotel. Dinner will be at a local restaurant (not included in the package).
Tuesday - Day 7
After breakfast, you’ll enjoy a full day of sightseeing and shopping on your own. A suggestion list for sightseeing and shopping will be provided for you. Tonight we will see the Broadway play “Ain’t Too Proud: The Life and Times of the Temptations”. Show time 8pm.
Wednesday - Day 8
After breakfast we take the train to Harlem, and we will have a guided tour of the Schomburg Center for Research in Black Culture. It is an archive repository for information on people of African descent worldwide. It was founded in 1925 by Arturo Alfonso Schomburg, an Afro-Puerto Rican Scholar. In 2017 it was named a National Historic Landmark. Across from the Schomburg Center is Harlem Hospital. I worked at Harlem Hospital as the Director of their Adult and Pediatrics Emergency Services for four years in the 80’s. Dinner will be at 5pm at a local restaurant in Harlem, after which we will attend Amateur Night at the world famous Apollo, at 7:30pm.
Thursday - Day 9
Depart for home. Super Shuttle will pick us up at the hotel for departure to JFK airport.
A signed and completed registration form must accompany the initial deposit. All prices are quoted per person based on double occupancy.
Deposit & Final Payment
A non-refundable deposit of 335.00 is due by February 12, 2019;
Monthly installments due thereafter:
March 19, 2019: $350.00;April 16: $350.00;May 21: $350.00;June 18: $350;July 18, 2019: $350;August 20: $350;Final payment due September 16, 2019
Make checks payable to Sweetwine Travel Services; 23110 State Road 54, #402, Lutz, FL, 33549
Passports and Visas
All passengers are responsible for assuring they have the proper (legal) documents required for travel. A birth certificate and valid US passport is required. The passport must be valid for six months beyond your travel date. Names provided to Sweetwine Travel Services for customers must be an exact match to the photo ID that will be used during travel. Passengers must check with the respective consulate (s) or Visa agency to determine whether visas are required. Visit www.travel.state.gov for up to-date requirements.
The customer is responsible for all fees and expenses that may be incurred due to an incorrect name, or to the denial of travel due to an incorrect name. A name revision fee will be assessed by Sweetwine Travel Services of $75.00 for name corrections or revisions, in addition to other fees assessed by airlines or other suppliers.
Health Requirements
Check with your healthcare provider for up-to-date requirements. You may also check the Center for Disease Control www.cdc.gov for their recommendations. Required inoculations, if any must be recorded by passengers health practitioner on a valid vaccination certificate which the passenger must carry for proof of inoculation where required.
Airfare
Airfare once purchased is non-refundable. However some airlines may allow usage of ticket for one year from date of original travel. It is the responsibility of the traveler to check with the airline. Sweetwine Travel is not responsible for any change/cancellation penalties associated with these non-refundable airfares.
Airline Seat Assignment
As a courtesy service, airline seat assignments are requested
on your behalf. Some airlines do not allow for pre-seating and require this be done at airport check-in only.
Airline Frequent Flier Programs
Passengers are responsible to contact their airline directly regarding mileage eligibility and accrual. Airline frequent flier programs determine whether to award miles in part or total based on their own rules, which are updated frequently. We highly recommend passengers to provide their frequent flier account information at check-in or online.
Airline Taxes & Fuel Surcharges
If you purchase airfare, airline taxes and fuel surcharges are included. Prior to completion of full payment there is a potential for a price increases(s) due to increases in government-levied taxes and fees and /or fuel surcharges. To avoid potential air increases you may choose to accelerate your final payment in order that your tickets may be issued. Once issued, airline tickets are no longer subject to potential increases.
Cancellation Policy
All requests for cancellation must be in writing to Sweetwine Travel Services. Initial deposits are non-refundable. For cancellations, the following per person cancellation fees apply.
89-75 days prior to sailing: 25% per guest
74-61 days prior to sailing: 50% per guest
60-31 days prior to sailing: 75% per guest
30-0 days prior to sailing: 100% per guest
If a guest cancels within 90 days to departure resulting in a single supplement charge, the guest who is cancelling will be responsible for that charge.
Reservations & Deposits
Reservations should be made as early as possible to guarantee desired departure dates. A non-refundable deposit is due at the time of reservation. If payment is not received by the due date, airline and all other reservations will be cancelled. Sweetwine Travel is not responsible for any penalties, fare increases or fees incurred due to late payments. Last minute reservations made within thirty days of departure must pay by credit card, money order, certified check or debit card. Credit card payments are subject to a 3-5% service fee in addition to the total cost of the trip.
Code of Conduct
For all tours we aim to foster an environment of respect that allows al our guests to enjoy their group vacation. Guests, who are disruptive, endanger the group or the travel experience, or break local laws may be removed from the program with no refund due and at their own expense. Sweetwine Travel Services reserves the right to accept or reject any program guest.
PROGRAM TERMS AND CONDITIONS
Unused Services
No refund will be made for any service in the Tour Price that is not utilized by the guest and in the event that the guest does not utilize any part of the scheduled itinerary for any reason whatsoever, such guest shall be responsible at own expense for all and any substitute arrangements.
Name Changes
Name changes require the prior approval of Celebrity cruise and may not always be possible. Name changes are considered reservation cancellations and are subject to cancellation fees. Any non-refundable deposits paid on the original account will not apply to the new booking. The new booking made will be subject to normal non-refundable deposit requirements. Any substitutions accepted represent new bookings subject to the rates and discounts available at the time of substitution.
Guest Responsibilities
Guests are required to verify that the information shown on their reservation/registration is correct. Guests will be responsible for any and all change fees with airlines, and other providers in result of incorrectly advised names, visa and passport information.
Special Requests
If you have a special request for a facility or service e.g., adjoining rooms or low floor, we shall pass these on to the relevant supplier but cannot guarantee that it will be met and we shall have no liability to you if it is not met.
Tour Prices
All prices are charged per person based on two persons sharing a room. Sweetwine Travel is not responsible for roommates or matching guests. All tours are based on tariffs, taxes, and rates of exchange in effect at the time of printing. Sweetwine Travel Services reserves the right to increase tour prices due to fluctuations in tariffs, taxes of exchange, or group reductions. These rates are subject to increase without notice. If such rates change prior to departure surcharges may also apply.
Physical Disabilities
Customers requiring special facilities, services or accommodations must disclose such needs to Sweetwine Travel Services at time of reservation. Wheelchair-accessible transportation and accommodations may be requested, but cannot be guaranteed. Available accommodations standards vary by hotel/cruise ship and are not within the control of Sweetwine Travel Services. Your foreign destination may not conform to the United States Americans with Disabilities Act requirements, and facilities for disable persons may be extremely limited. Sweetwine Travel Services assumes no liability for the failure for the provision of accommodations by a travel vendor.
Baggage Fees
Additional fees for baggage may apply. Please contact the airline or refer to its website for detailed information regarding their checked baggage policies.
Travel Protection
Now’s the time to consider purchasing a travel protection plan to help protect your vacation investment. For more information on the available plans or to enroll, go to www.travelexinsurance.com or contact Travelex Insurance Services at 800-228-9792 and reference location number 05- 1125. Travel Insurance is underwritten by Berkshire Hathaway Specialty Insurance Company, NAIC #22276. W20.
Passenger Agreement
All passengers are required to complete a passenger reservation form prior to travel and, by so doing formally accept Sweetwine Travel Terms and Conditions, Release from Liability, and Assumption of Risk Agreement. Passengers booking online will be required to complete the passenger reservation form at the time of booking. Travel documents will not be released without a completed Passenger reservation form.
Release of Liability
Sweetwine Travel Services does Not own or operate any entity that provides good and or services for your travel including, without limitation: lodging facilities, motor coach or other transportation companies, guides or guide services, local ground operators, providers or organizers of optional excursions, food service providers etc. All such persons and entities are independent contractors and not affiliated with Sweetwine Travel Service. As well Sweetwine Travel Service is not liable for any negligent or willful act or failure to act on the part of any travel service provider or any third party. Sweetwine Travel Service is not responsible for any injury, loss, death, inconvenience, delays, or damages to persons or property in connection with the provisions of any goods or services, whether resulting from but not limited to acts of God or force majeure, illness, disease, acts of war, or civil unrest, insurrection or revolt, animals, strike or other labor union activities, criminal or terrorist activities of any kind, overbooking or downgrading of accommodations, mechanical or other failure of airplanes or other means of transportation, or any failure of any transportation mechanism to arrive or depart on time. If due to weather, flight schedules, or other uncontrollable factors requiring you to spend additional nights you will be responsible for your own hotel transfer fees and meals cost.
Assumption of Risk
Passengers are required to sign a Release of Liability and Assumption of Risk Form.
Liability Disclaimer
Sweetwine Travel is not responsible for any errors, omissions or misquotes contained in their brochure, flier, invoices or other promotional documentation. The content of said brochure or promotional documentation, invoices may be changed anytime (including but not limited to rates and itinerary) without notice and at Sweetwine Travel sole discretion. Sweetwine Travel reserves the right to re-invoice if we have displayed the incorrect amounts. Sweetwine Travel Terms can be changed at any time. In no event shall Sweetwine Travel be liable for any
direct, indirect, punitive, incidental, special or consequential damages arising out of, or in any way connected with the use of this website, or for any information, products, and services obtained through this website, or otherwise arising out of the use of this website.
Sweetwine Travel Services is acting as a mere agent for SUPPLIERS (identified on the accompanying documents) in selling travel-related accepting services, or in accepting reservation or bookings for services that are not directly supplied by Sweetwine Travel Services (such as air and ground transportation, hotel accommodations, meals, tours, cruises, etc.). Sweetwine Travel Services, therefore, shall not be responsible for breach of contract, failure to comply with any laws such as the Americans with Disabilities Act (ADA), or any intentional or negligent actions or omissions on the part of such suppliers, which result in any loss, damage, delay, inconvenience, injury to travelers or travelers’ companions or group members.
Unless the term “guaranteed” is specifically stated in writing on your tickets, invoice, or reservation itinerary, Sweetwine Travel Services does not guarantee any of such supplier’s rates, bookings, reservations, connections, scheduling, or handling of baggage or other personal effects. Travelers who have done due diligence, are aware of the quality of the hotel accommodations chosen, and or chosen by the Group Leader, and agree that Sweetwine Travel Services will not be responsible if they are not satisfied.
Risks, Cancellations
Traveler assumes complete and full responsibility for, and hereby releases Sweetwine Travel Services from, any duty of checking and verifying any and all passport, visa, vaccination, or other entry requirements of each destination, and all safety and security conditions of such destinations, during the length of the proposed travel. It is the passenger’s responsibility to have proper passports or government issued IDs where permitted. Sweetwine Travel Services shall not be responsible for any injuries, losses, or damages in connection with terrorist activities, social or labor unrest, mechanical or structural integrity of air, sea, and ground transportation and accommodations, diseases, local laws, bankruptcy or cessation of supplier or carrier services, climatic conditions, Acts of God, delays, changes or cancellation of travel due to weather conditions, hotel services, accidents or health related problems before or while in-transit to (e.g., an accident on the way to a tour), during, and after a tour, or any other actions, omissions, or conditions outside of Sweetwine Travel Services’ control.
If travel plans are delayed or cancelled for any reason, there will be no refunds issued by Sweetwine Travel Services. There will be no refunds for cancellations made up to or less than 90 days before departure, including cancellations due to actual or threatened terrorist events. There will be no refunds due to fear
of travel from actual or threatened terrorist events. There will be no refund for unused land or air arrangements.
By embarking upon his/her travel, the traveler voluntarily assumes all risks involved in such travel, whether expected or unexpected. Traveler is hereby warned of the above risks as well as possible travel industry bankruptcies and medical and climatic disruptions, and the possibility traveler may be unable to travel as scheduled because of personal emergency.
For information concerning possible dangers at international destinations, contact the Travel Advisory Section of the U.S. State Department, (202) 647-5225, or access the State Department’s online travel advisory service: travel.state.gov/travel/warnings.html. For medical information, call the U.S. Centers for Disease Control (CDC), (404) 332-4559 or www.cdc.gov/travel.
Traveler’s retention of tickets, reservations, or bookings after issuance shall constitute a consent to the above and an agreement on his/her part to convey the contents hereto to his/her travel companions or group members.
California Seller of Travel
Sweetwine Travel Services is a registered Seller of Travel with the State of California registration # 2035553-40. California law requires certain sellers of travel to have a trust account or bond. Sweetwine Travel has a trust account and is required to deposit 100% of all customer funds into a business account. Sweetwine Travel Services is not a participant in the California State Consumer Restitution Program.
For Registration or Questions Contact: Sweetwine Travel Services Phone: (510) 834-7690 Fax: (800) 878-6386 Make checks payable to: Patricia Sweetwine Travel 23110 State Road 54, #402, Lutz, Florida 33549 CST# 2035553-40
Registration as a seller of travel does not constitute approval by the State of California.
Sweetwine Travel Services CST #2035553-4023110 State Road 54, #402, Lutz, Florida 33549 | PHONE (510) 834-7690 FAX (800) 878-6386 | [email protected]
NEW YORK STATE & NEW YORK CITY REGISTRATION FORM
TOUR PARTICIPANT INFORMATION:
Name:
Address:
City: State: Zip Code:
Phones: Mobile / Cellular: Message:
Day: Evening: Fax:
Email Address:
Departure City:
Passport Number: Issue Date: Expiration Date:
Date of Birth: Sex / Gender:
Roommate:
Sex / Gender:
EMERGENCY CONTACT INFORMATION:
Contact Person:
Relationship:
Mailing Address:
City: State: Zip Code:
Email Address: Phone(s):
Method of Payment:
oPersonal Check oMoney Order oCredit Card
SIGNATURE CONFIRMATION:
I certify that I have read and agree to all the terms and conditions noted.For complete terms and conditions, go to www.sweetwinetravel.com.
Signed: Date:
Travel Protection
We recommend that all travelers purchase travel insurance for their vacation package. If you wish to purchase Travel Protection, contact us for more information.
oI decline Travel Insurance. Signed: Date:
Sweetwine Travel Services CST #2035553-4023110 State Road 54, #402, Lutz, Florida 33549 | PHONE (510) 834-7690 FAX (800) 878-6386 | [email protected]
CST #2035553-‐40 23110 State Rd. 54 #402, Lutz, FL 33549
PH (510) 834-‐7690 | Fax (800) 878-‐6386 | [email protected]
Confidential Personal Form Providing Information for Use in Medical Emergencies — KEEP THIS FORM WITH YOU WHILE TRAVELING —
INFORMATION CONCERNING YOU
Full name as it appears on your passport: Name or nickname you are called: Passport number: Office where issued: Passport date of issuance: Passport date of expiration: Street address: City: State: Zip: Date of birth: Month Day Year
INFORMATION CONCERNING THE PERSON TO BE CONTACTED IN THE EVENT OF AN EMERGENCY
Name: Street address: City: State: Zip: Home phone: Work phone: Relationship of this person to you:
INFORMATION CONCERNING YOUR PHYSICIAN
Name of your physician: Street address: City: State: Zip: Your physician’s office phone: Your physician’s home phone: Your physician’s answering/paging service phone:
INFORMATION CONCERNING MEDICATIONS AND YOU
List the prescription drugs and medicines you are presently taking. Generic name, exact strengths, and dosage of each medication would be invaluable. 1. 4. 2. 5. 3. 6. List all drugs and medicines to which you are allergic. 1. 4. 2. 5. 3. 6. List any unusual medical conditions that you feel it would be helpful for a physician to know in the event you required emergency medical attention during the tour.
EMERGENCY AUTHORIZATION To whom it may concern: I, the undersigned, hereby give any licensed, practicing physician or hospital full authority to provide emergency medical treatment for me in the event such treatment is needed or necessary and I am not able to make such a decision. I also hereby give my permission for a licensed practicing physician to administer whatever medical treatment s/he may deem necessary for me in the event of any medical emergency affecting me. Signed: Date: Witness name: Witness signature:
CST #2035553-‐40 23110 State Rd. 54 #402, Lutz, FL 33549
PH (510) 834-‐7690 | Fax (800) 878-‐6386 | [email protected]
Release of Liability and Assumption of Risk
I, , HEREBY ACKNOWLEDGE I am aware that during my
participation in a Sweetwine Travel Service tour program, certain risks and dangers may arise, including, but not limited to,
the hazards of traveling in undeveloped areas; travel by boat, train, automobile, tour buses, aircraft or other means of
conveyance; the forces of nature; political unrest; and accident or illness in remote regions without means of rapid
evacuation or medical facilities. I am also aware and clearly understand that Sweetwine Travel Service will not have liability
regarding provision of medical care or the adequacy of any care that may be rendered.
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE
OF OTHERS. As lawful consideration for the agreement with Sweetwine Travel Service to participate in such trips and
activities, I hereby agree that I will not make a claim against Sweetwine Travel Service or sue for bodily injury, emotional
trauma, death, and/or property damage, however caused, as a result of my participation in the tour program. I therefore
release Sweetwine Travel Service and its employees from any and all claims, actions, and demands, known or unknown,
that I may have arising from my participation in the tour program.
This Release of Liability and Assumption of Risk agreement is entered into on behalf of all members of my family, including
minors, accompanying me. This agreement is binding on my heirs, legal representatives, and assigns. If any portion of this
agreement is unenforceable, the remaining portions shall remain in full force and effect.
I certify that I have read and agree to all terms and conditions of this release as well as all terms and conditions
accompanied with this travel package.
I understand that Sweetwine Travel Service has travel insurance available for my purchase. This protects against losses
resulting from trip cancellation or interruption, medical expense, emergency medical transportation, and baggage/personal
effects. Should I decline the offer of travel insurance, I understand that I am assuming any financial loss associated with my
travel arrangements which otherwise may have been covered by travel insurance.
NOTE: Each traveler, including couples traveling together, must individually sign a copy of this agreement.
Scan and email, or mail to the above address.
Signature of Participant Date
Name
Address City, State, Zip Code