70+ New Zealand This form is to sign up and make a deposit for the 70+ New Zealand trip. The form shows the total trip cost but only collects the deposit ($1000/per person). How many people is this deposit for?* 1 2 Are you a club member?*Family members and friends of members are welcome to participate! Yes No Name* First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneEmail* 2nd Person NameName* First Last Where will you originate from? If you are meeting the group at LAX, enter LAX. If you need a connecting flight from a different city, please enter that airport code/city.If you are booking your own connecting flight, enter LAX. Trip Selection* Please assign a roommate ($3995) I prefer a single room ($5120) Trip Selection*Bed preference (where available) We are a couple (2-beds) $6990 We are a couple (1 -bed) $6990 Flight Upgrades*Airfare Upgrades - International Portion Only (round trip). None Sky Couch (1 person) +$2420 Premium Economy +$3260 Business Premier +$5975 Flight Upgrades*Airfare Upgrades - International Portion Only (round trip). None Sky Couch (1 person) +$4840 Sky Couch (2 person) +$2700 Premium Economy +$6520 Business Premier +$11950 Hawaii add on* No Yes +$1350 Hawaii add on* No Yes (shared room) +$675 Yes (single room) +1295 Please upload a copy of your passport (or text to 401-440-0297) Drop files here or Select files Max. file size: 64 MB, Max. files: 2. TotalForm shows the total cost but will only collect a deposit of $1000 per person. $0.00 Additional InformationI understand cancellation policy*Cancellation Policy (No Shows are Non-Refundable) Prior to May 10, 2023 forfeit $100.00 per person - Between May 11- June 11, 2023 forfeit $500 Per Person - Between June 11-July 10, 2023 forfeit $1500 Per Person - After July 10, 2023 NO REFUND. Trip insurance is strongly recommended. Yes No I agree to waiver*Waiver: I understand and am aware that skiing is a HAZARDOUS activity. I understand that the sport of skiing, travel to and from the ski area and other activities with the 70+ Ski Club involve a risk of injury to all parts of my body. I understand the risks associated with COVID-19. I hereby agree to freely and expressly assume all risks of injury while skiing, travel to and from the ski area and activities with the 70+ Ski Club. I agree that I will release the 70+ Ski Club and its officers from any and all responsibility for injuries, illness, or damages to me or to any other person. I have carefully read this agreement and release of liability and fully understand its contents. I am aware that this is a rule of liability and a contract between me and the 70+ Ski Club. Yes No Emergency Contact (Name and Phone Number)* Comments / MessagePlease list any special requests including any food restrictions, or preferred roommatesCAPTCHACredit Card (**only the deposit will be charged, but the form shows the total trip cost**) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Δ
