RESERVATION FORM Please read carefully before signing. You must sign and return via mail or fax to have a confirmed reservation. Payment / deposit should be made payable to Ultimate Africa. A separate form must be filled out for each traveler. Photocopy this form for multiple applicants. Privacy: All information is used only by Ultimate Africa and contracted tour operators / airlines in planning your tour. Please reserve ___ space(s) I have enclosed full payment or a non refundable deposit of US$500 / 20% of land cost per person, for a total of US $ ___________. Applicant's Legal Name (as it appears on passport) ____________________________________________ Passport Number __________ Issue Date __________ Expiration Date __________ Place of Issue __________ Nationality of Passport __________ Citizenship Place of Birth ____________________________ Address ____________________________ City____________________________, State__________, Postal Code__________, Country __________ Telephone/Fax/Email at Residence ____________________________ Telephone/Fax/Email at Work ____________________________ Sex ___ Height ___ Weight ___ Age ___ Date of birth (MM/DD/YR)__________ Occupation ____________________________ Physical Condition ______________________ Special Dietary Requirements ______________________ Health Concerns ____________________________ Name of Emergency Contact ____________________________ Address ____________________________ Telephone at Residence _______________________ Telephone at Work ____________________________ Air transportation Departing from (closest major airport) ____________________________ Returning to ____________________________ Frequent Flyer Information ____________________________ People who occupy single rooms pay a single supplement fee on most tours. Single tents are not always available. I will share a double room with ____________________________ Please assign a roommate if available___ I prefer a single room ___ Smoking ___ Non Smoking ___ Where did you hear of Ultimate Africa? ____________________________ I accept the conditions and responsibilities outlined in the terms and responsibilities (Please duplicate this form when completed for your own records). Signature ____________________________ Date ____________ Signature of parent or guardian of participant (if applicant is under 18 years of age) ____________________________ *If I am signing on behalf of a minor I agree to RELEASE, HOLD HARMLESS AND INDEMNIFY the entities named above for any claims of the minor. RESERVATION FORM MUST BE SIGNED AND RETURNED ALONG WITH YOUR DEPOSIT, A SIGNED LIABILITY RELEASE / ASSUMPTION OF RISK AGREEMENT AND A SIGNED INSURANCE ACCEPTANCE / WAIVER FORM. ULTIMATE AFRICA SAFARIS - TERMS AND
CONDITIONS Ultimate Africa is a trading name of Ultimate Adventures Inc., a corporation registered in the state of Washington. Registered seller of travel #601730459 Reservations and Payments: Reservations are confirmed on receipt by Ultimate Africa of a signed booking form and a US$500 or 20% of land cost deposit per passenger (deposit amount will be specified on each individual itinerary). No portion of the deposit is refundable. The balance of payment is due 75 days prior to departure. If a reservation is made within 60 days of the trip departure the entire amount of the trip must be submitted at the time of confirmation. All reservations are automatically canceled if all payments are not received by the due date, with full loss of trip deposit. Airfare is due at the time the tickets are issued, usually 2 to 4 months prior to trip departure. All prices are quoted in US dollars and all payments must be made in US dollars. Prices are based on tariffs and exchange rates in effect at time of this writing and are subject to change without notice, even after you have confirmed your trip. Some of our overseas operators have payment schedules that differ from the above. Should they differ you will be advised at time of booking. Deposits and payments for the land portion of a trip are by check or cash only. A credit card may be used to purchase the air portion of the trip. Reservation amendments: All reservation amendments made within 60 days of trip departure will be charged at the cancellation penalties detailed below. Cancellation and Penalties: All cancellations must be made in writing, signed by the client, to Ultimate Africa and all trips are subject to the following, per person, cancellation charges based on the number of days before trip departure that we receive your written cancellation request: More than 60 days: Loss of deposit / Between 30 and 60 days: 50% of trip cost per person / Less than 30 days: No refund of trip cost Some of our overseas operators have cancellation fees that differ from the above. Should they differ you will be advised at time of booking and the higher fees prevail. Refunds: All refunds will be processed 30 days after we receive your letter of cancellation, and are calculated as of the day we receive your written verification. In the unlikely event that the trip itself is canceled by Ultimate Africa prior to the commencement of the trip due to circumstances beyond our control, and you are unable to schedule for another time, all moneys are refundable, with the exception of your personal trip expenses (e.g. non refundable "advanced purchase" air tickets).There is no refund for any unused portions of a trip once the trip has commenced. If you cancel while the trip is in progress there will be no refund for the unused portion. Insurance: A comprehensive travel insurance policy including trip cancellation and interruption, baggage, accident, emergency assistance and medical expense is mandatory. Rescue and Medical Assistance: In the unlikely event of rescue and medical assistance being needed the participant shall be liable for the entire cost thereof, unless covered by insurance. Documentation and Health Requirements: A passport valid for at least 6 months after your return is required for all US citizens. A confirmation letter, invoice, air / land itinerary, and insurance information will be delivered immediately after trip sign up. Airline tickets are delivered upon payment. By forwarding the trip deposit and signed reservation and release form, the passenger certifies that he/she does not knowingly have any physical or other conditions of disability that would create a risk for himself/herself or other trip participants. A release of liability form must be signed by each participant prior to commencement of the trip. Participation by any trip member will be declined in absence of the signed release of liability form, with no trip fee refund. Any required inoculations must be recorded by the client's health practitioner on a valid vaccination certificate which the client must carry in his/her possession. Ultimate Africa will not assume responsibility for the accuracy of any medical information. You should check with your health care provider for up to date requirements and personal recommendations. Travel documents as well as compliance with customs regulations are the responsibility of the client. Visas are the client's responsibility. Ultimate Africa, its owners, agents, or employees cannot be held liable for lack of visas not held by clients. Tour costs: Tour price includes all features listed in individual itineraries. All tour costs are based on all known costs and rates of exchange at the time of booking and any significant changes beyond the control of Ultimate Africa will be passed on to the passengers. Air costs are subject to government approval and may change without notice. An increase in tour price shall not be sufficient grounds for any refund paid for the tour. Airfares: Airfares are subject to change without notice prior to ticketing. Ultimate Africa is not responsible for any airline schedule and airfare changes, cancellations, overbooking or damage or loss of baggage and property. All claims for any loss or injury suffered on any airline must be made directly with the airline involved and Ultimate Africa. Air schedule changes may necessitate additional nights being added to your tour. These schedule changes are beyond the control of Ultimate Africa and any resulting additional costs must be borne by the passenger. A warning about budget airfares: Since there is always the possibility of delay when participating in an adventure travel trip, please keep in mind that many budget airfares carry restrictions. In many cases these tickets are non refundable, non endorsable (valid only on the carrier listed), require advance purchase, are valid on for travel on specific dates, and may involve traveling by an inconvenient route. The land price does not include (unless stated): Airport departure taxes where levied, passport and visa fees, cost of personal trip cancellation and baggage insurance, excess baggage charges, medical costs, evacuation from remote areas, all items of a personal nature such as laundry, beverages (alcoholic and soft drinks and bottled water), client communication expenses, room service, optional excursions, or deviations from the scheduled tour, meals not featured in the program, and gratuities for the driver/guide, porters and camp staff. If any tour is delayed due to weather or road conditions, flight delays, illness, or other contingency over which Ultimate Africa or its agents and contracted tour operators have no control, the cost incurred by such delay is not included. Alteration of Tours: Ultimate Africa reserves the right to alter, amend or completely cancel the whole or portion of a trip itinerary as necessary if, in the opinion of Ultimate Africa or its independent contractors or service providers, such alterations or amendments are necessary. There shall be no refunds or credits for amendments to the trip itinerary and Ultimate Africa further reserves the right to substitute accommodations of similar category. Ultimate Africa reserves the right to cancel any trip due to inadequate sign-up which makes the trip economically unfeasible for us to operate. In such a case a full refund of the land cost is given, but Ultimate Africa is not responsible for additional expenses incurred by members in preparing for the trip. A trip cancellation for insufficient sign up would normally occur at least 30 days before departure. Airlines impose stiff penalties for changes (including name changes) once tickets are issued. Please ensure that your full name as it appears on your passport is used when making your reservation. Responsibility: Ultimate Africa of Issaquah, Washington and its owners, outfitters, agents and employees act only as agents for the passenger with respect to services provided, included but not limited to, hotels, restaurants, sightseeing, and all forms of transportation. All tour services are provided by independent contractors who are not owned or controlled by Ultimate Africa. Ultimate Africa assumes no responsibility or liability (shall not be responsible or liable for) for injury, death, damage, loss, accident, delay or change in air or other services howsoever caused, irregularity, inconvenience or additional expenses which may be occasioned directly or indirectly by either reason or defect of any vehicle, act of war, insurrection, revolt, government restrictions and regulations, or other civil uprisings or disturbances, military action, quarantines, strikes, weather, sickness, wars, theft, pilferage, force majeur, wild animals, failure of any means of conveyance to arrive or depart as scheduled, overbooking, travel advisories, discrepancies or changes in transit , hotel and other services over which it has no control, or any act of God occurring in either the country of origin, destination or through passage, or for any reason whatsoever, or through the acts or default of any company or the persons engaged in conveying the passengers or in carrying out the arrangements of the tours. All such losses or additional expenses will be the sole responsibility of the member of the tour as the rates are provided are for the arrangements only at the time stated. Ultimate Africa may not be held responsible for any loss or damage to luggage, before, during, or after the tour program. On advancement of deposit to Ultimate Africa the depositor therefore agrees to be bound by the above recited terms and conditions. Ultimate Africa reserves the right to accept or decline any individual from participating on any of our tour programs for any reason. Ultimate Africa will not discriminate against any individual because of race, religion, sex, sexual preference, or nationality. Airline Responsibility: The sole and exclusive responsibility and liability of any airline shall be in accordance with and as limited by the contract of carriage in the passenger's ticket, the applicable tariffs and the provisions of the Warsaw Convention. The airlines shall not be responsible or liable for any act, omission, or occurrence during the time the passengers are not on board its' aircraft or conveyance. The passage contract in use by the airlines concerned, when issued, shall constitute the sole contract between the airlines and such purchasers of these tours and/or passenger. Such conveyance, etc., is subject to the laws of the countries involved. Ultimate Africa is not responsible for additional hotel nights, not specified in itineraries, which may be required en route, prior to or following a trip, caused by airline schedule changes. All of the tour services other than transportation provided by the airline, are provided by independent contractors that do not act on behalf of the airline and with whom the airline does not have a direct business association or relationship. No airline is responsible or liable for the accuracy of the tour brochure or representations made by Ultimate Africa. Flights are occasionally subject to overbooking or cancellation. If this occurs, Ultimate Africa will do all possible to assist clients in boarding or finding alternative arrangements. It must be stressed that this is done as a courtesy to clients and Ultimate Africa cannot be held responsible for denied boarding, nor for the additional costs thus incurred, nor for moneys not recovered for missed land arrangements due to airline delays.
LIABILITY RELEASE AND ASSUMPTION OF RISK
AGREEMENT Voluntary Participation and Assumption of Risk I acknowledge that I have voluntarily chosen to participate in the trip designated on this application (or a trip I may change to). In so doing, I acknowledge that I may be subjecting myself to dangers and hazards, which could result in illness, injury, or death. I also acknowledge that there are inherent risks and dangers, which may arise at any time during the trip. I am specifically familiar with and accept the risks of the dangers and hazards referred to in the trip materials, which have been provided to me. I am aware that medical services or facilities may not be available while I am participating in the trip. In order to partake of the enjoyment and excitement of this adventure travel trip I am willing to accept the risks and uncertainty involved as being an integral part of my adventure. I agree to assume all risks of illness, injury or death. I VERIFY THAT I UNDERSTAND AND ACCEPT THIS STATEMENT BY PLACING MY INITIALS HERE: ___ Release and Covenant not to Sue I understand that Ultimate Adventures Inc. d.b.a. Ultimate Africa will contract with independent contractors to provide services on this trip, including transportation, travel services and guide services. I understand and acknowledge that Ultimate Adventures Inc. has no control over and assumes no responsibility for the actions of any independent contractors, and that no independent contractor has authority to make commitments for or on behalf of Ultimate Adventures Inc. As partial consideration for my being permitted to participate in the trip and for Ultimate Adventures Inc.’s undertakings, I agree that neither I, nor any of my heirs, personal or legal representatives, or family members will bring suit against Ultimate Adventures. Inc., a Washington corporation doing business as Ultimate Africa, as a result of any acts or omissions by Ultimate Adventures Inc. or its independent contractors. I hereby release, indemnify, and covenant not to sue Ultimate Adventures Inc., a Washington corporation d.b.a. Ultimate Africa, or its officers, directors, shareholders, agents, employees, contractors and other persons or entities involved with this trip, for any and all claims of whatever kind arising from my participation in the trip, including, but not limited to, personal injury, illness, death, damage, or monetary losses. I VERIFY THAT I UNDERSTAND AND ACCEPT THIS STATEMENT BY PLACING MY INITIALS HERE: ___ Arbitration Any controversy or claim arising out of or relating to this agreement or the performance thereunder, including without limitation any claim related to illness, injury, or death, shall be settled by binding arbitration in Washington state, in accordance with the Commercial Arbitration Rules of the American Arbitration Association then existing, and judgment on the arbitration award may be entered in any court having jurisdiction over the subject matter of the controversy. This agreement to arbitrate does not waive or modify the liability release contained in the foregoing paragraphs. I VERIFY THAT I UNDERSTAND AND ACCEPT THIS STATEMENT BY PLACING MY INITIALS HERE: ___ Knowing and Voluntary Execution I have carefully read Ultimate Adventures Inc. reservation information, I have familiarized myself with all the information provided to me about this trip, and I agree to all stated conditions set forth in the reservation information, specifically including the section outlining my responsibilities and obligations as a trip member. I have also carefully read and agree to the terms and conditions of this agreement. I understand that it is a release of liability and a contract between myself and Ultimate Adventures Inc. and/or its contracted tour operators or affiliated organizations, and I sign this agreement of my own free will. This agreement is binding on my heirs, legal representatives and assigns. I VERIFY THAT I UNDERSTAND AND ACCEPT THIS STATEMENT BY PLACING MY INITIALS HERE: ___ Integration and Severability Subject to the obligations and duties set forth herein, this Liability Release and Covenant Not to Sue, the Ultimate Africa Reservation Form, Ultimate Africa Terms and Conditions and Travel Insurance Acceptance/Waiver, all of which are incorporated herein by this reference, express the full and complete agreement and contract of the parties hereto. In the event that any term or terms of these documents are declared invalid by an arbitrator or court of law, such declaration shall not affect the remainder of the terms of the agreement, which shall be valid and enforceable. Participant Signature _________________________ Date __________ Signature of parent or guardian of participant (if applicant is under 18 years of age) _________________________ If I am singing on behalf of a minor I agree to RELEASE, HOLD HARMLESS AND INDEMNIFY the entities named above for any claims of the minor. Declaration of Witness I certify that ________________________acknowledged in my presence that he/she read and fully understood the meaning and consequences of the foregoing release and signed it in my presence. Executed this day, the ___of ___________________, 20___ Signature of witness ____________________________ Printed witness name _____________________________ Address ___________________________
TRAVEL INSURANCE ACCEPTANCE Dear traveler: Your upcoming trip is a significant investment, which involves risks. For this reason, we require that all Ultimate Africa clients purchase a comprehensive travel insurance plan valid for the entire duration of your trip. This should cover you for events such as trip cancellation, delay or interruption, lost or delayed baggage, emergency accident, sickness and evacuation, 24 hour medical assistance, traveler's assistance, and emergency cash transfer. For coverage we suggest Travelguard Insurance. You may send your insurance coverage payment to our office along with your trip deposit and we will complete the insurance formalities on your behalf. The total premium will be based on each traveler's age and total per person trip price including air tickets. Please contact our office for an insurance premium quote. Alternatively you may visit Travelguard online at http://www.travelguard.com . For our insurance records please reference Ultimate Africa Safaris #51779 when applying for insurance over the internet or by phone. Please read the Travelguard brochure/application for a complete description of the travel insurance benefits and assistance services. ___ I have read the brochure/application and have purchased a Travelguard Comprehensive Tour Protection plan ___ I have decided to purchase a comprehensive tour protection plan from another insurance company and have included contact details so you may confirm my/our coverage. Signature___________________________ Date _______________ Printed Name___________________________ Trip Dates________________________ Insurance Company___________________________ Policy Number________________ Insurance Company Telephone Number _________________
CREDIT CARD CHARGE AUTHORIZATION Please read carefully before signing. If you are making your trip deposit or purchasing air tickets or trip insurance with a credit card you must sign and return via mail or fax to have a confirmed reservation. Dear traveler: Reservations are confirmed on
receipt by Ultimate Africa of a US$500.00 non-refundable deposit or 20% of the land cost
non-refundable deposit per person depending upon which tour is booked (the deposit amount
will be noted on each personalized itinerary). Some overseas tour operators have deposit /
payment schedules that differ from the above. Should they differ you will be advised at
time of booking. Deposits may be made by credit card
(MasterCard, Visa or American Express) or by personal, business or certified check made
out to Ultimate Africa Safaris and posted to our office. Air tickets and trip insurance
may be paid by credit card (MasterCard, Visa, or American Express) or check. Client's who
do not purchase comprehensive travel insurance cannot make their deposit by credit card.
Please note that airfares are subject to change over time. Final trip payment is due 75 days
prior to departure. Your final land payment may be made by personal, business or certified
check made out to Ultimate Africa Safaris and posted to our office. We regret that your
final land payment may not be made by credit card however a credit card check is
acceptable. If a reservation is made within 75
days of the trip departure the entire amount of the trip must be submitted at the time of
confirmation. Reservations may canceled if all payments are not received by the due date,
with full loss of trip deposit. Reservation amendments within 60
days of trip departure may be charged at the cancellation penalties detailed below. All
cancellations must be made in writing, signed by the client, to Ultimate Africa and all
trips are subject to the following, per person, cancellation charges based on the number
of days before trip departure that we receive your written cancellation request: More than 60 days: Loss of deposit Some of our overseas operators have
cancellation fees that differ from the above. Should they differ you will be advised at
time of booking and the higher fees prevail. All refunds will be processed 30
days after we receive your letter of cancellation, and are calculated as of the day we
receive your written verification. There is no refund for any unused portions of a trip
once the trip has commenced. In the unlikely event that the trip itself is canceled due to
circumstances beyond our control, and you are unable to schedule for another time, all
moneys are refundable, with the exception of your personal trip expenses (e.g. non
refundable air tickets, visas, trip insurance premium). I have read the above reservation details and authorize Ultimate Africa Safaris to charge my non-refundable safari deposit totaling US $__________ to my ______________________ (enter type of card e.g. Mastercard, Visa). Please note card details below: ___________________________ _________________________________ _______________ ___________________________ _________________________________ _______________
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