Adriatic Coast, Italy

Personal Information

Mr.   Mrs.   Ms.   (circle one)

Name:  ____________________________________________________________

Address:  __________________________________________________________

__________________________________________________________________

City:  _________________________  State:  _________  Zip Code:  ___________

Daytime Telephone: ( ______ )  _____________________

Evening Telephone: ( ______ )  _____________________

Passport Information

Passport Number(s): ___________________________ Country of Issue: ____________

Expiration Date: _____________________   Date of Birth (mm/dd/yyyy): ____________

Please reserve space(s) for me/us on your upcoming trip to:

Shavuoth Vacation – June 6 to 11, 2008

[      ]   3-Star Maremonti Residence:  $1899  (50 m from hotel)

[      ]   4-Star Residence:  $2199  (across the street from hotel)

[      ]   Hotel: $2399

Prices are in USD, are pp/do, and include hotel stay, air and hotel transfer, taxes and gratuities.
Does not include any tours or airport transfer.

Trip Options (please check all that apply)

[      ]   I wish to share a room with _________________________________________

[      ]   I am travelling alone, but prefer a roommate. I understand that if one is unavailable, I must pay a supplement.

[      ]   I prefer to dine with: ______________________________________________

[      ]   I have these dietary requirements: ____________________________________

Please make your checks payable to: Ahavath Torah Institute

Travel insurance is strongly recommended. 

Credit Card Authorization

Name: (as appears on card)   ______________________________________________

Address:  __________________________________________________________

__________________________________________________________________

City:  _________________________  State:  _________  Zip Code:  ___________

I,  __________________________________ , hereby authorize the following charges to Ahavath Torah Institute:

Amount in $ US: _________

Card Kind:       [      ]   VISA       [      ]   MasterCard       [      ]   American Express

Card number: ________________________________________________

Expiration Date: ________________________

Signature:  ______________________________________

Where did you hear about us?

[      ]   Newspaper ___________________________________________________

[      ]   Internet ______________________________________________________

[      ]   Mailing        [      ]   Word of Mouth      [      ]   Other  __________________

ASSUMED RESPONSIBILITY

The AHAVATH TORAH INSTITUTE acts only as agents for the owners and/or contractors providing means of transportation, hotel accommodations and/or other services. All tickets, exchange orders and/or vouchers issued are subject to any and all terms and conditions, under which such means of transportation, hotel accommodations and/or other services are offered or provided. The issuance and acceptance of such tickets, exchange orders and/or vouchers shall be deemed to be consent to the further condition that AHAVATH TORAH INSTITUTE and/or its tour escorts shall not be or become liable or responsible in any way whatsoever, in connection with any loss, injury (whether or not resulting in death) and/or damage, howsoever caused or arising.  In addition, no responsibility or liability is accepted for additional expenses, losses, delay, injury, death or damage to property arising out of sickness, weather, acts of war, strikes, revolt, insurrection, military action, acts of violence, changes in air or other services or other causes beyond our control, whether occurring in the country of origin, destination or during travel.  Baggage and personal property are carried at the owner's risk entirely. The AHAVATH TORAH INSTITUTE reserves the right to change the itinerary or to cancel any tour prior to departure and return all collected funds. The right is also reserved to accept or to reject any person as a member of the tour at any point prior to travel. No refund will be made for ANY unused portion of any ticket or voucher.

As a condition to acceptance of any application, each applicant must agree to and sign the statement set forth below:

The undersigned has read the schedule of activities for this tour and recognizes and accepts any risks thereof. The undersigned also understands and hereby agrees for and on behalf of himself/herself, heirs, executors, administrators, and assigns, to abide by the conditions set forth above, and to release and hold harmless the AHAVATH TORAH INSTITUTE and any of its officers, trustees, agents, licensees, or representatives from any and all liability for delays, injuries, death, or for the loss of or damage to, his or her property however occurring during any portion , or in relation to the AHAVATH TORAH INSTITUTE'S tour described herein.

Date: _____________

Signature of Applicant(s): _____________________________________

If the application is made for, or by a person under 21 years of age, both parents or the applicant's guardian must also sign the application.