AMAZON PALM TOUR 2014

RESERVATION FORM

Dates: May 14th-23rd, 2014 (immediately before the Miami Biennial)

Reservations will be accepted in order of receipt of deposit checks.

Please complete and sign this form and return it with your deposit check in the amount of $400 payable to The New York Botanical Garden to: Andrew Henderson, The New York Botanical Garden, Bronx, NY 10458-5126.

Please type or print in black ink; use duplicate form for additional persons.

NAME_______________________________________________________________________

(as it appears on your passport)

ADDRESS ____________________________________________________________________

_____________________________________________________________________________

PHONE: Daytime: ( ) ______________

Evening: ( ) ______________

E-mail: ____________________________

DATE OF BIRTH ______________________ male: _____ female:_____

PASSPORT NUMBER_______________________ EXPIRY DATE __________________

(passports must not expire within 6 months after date of entry into Brazil)

NATIONALITY ___________________________________________________

________ I wish to share a cabin with ____________________________________

________ Please assign a roommate. Smoker __________ Non-Smoker__________

(There is no smoking in the cabins, at the dining tables, or in the canoes)

________ Enclosed is a deposit check in the amount of $400. Please reserve a space.

(If registering after December 6th, 2013, the second payment in the amount of $1250 is also due.)

________ I have read and consented to the conditions stated below.

Signature _________________________________ Date _________________

RESPONSIBILITIES & CONDITIONS: The New York Botanical Garden and its agents, affiliates, cooperating airlines and agencies act only in the capacity of agents in all matters of transportation and tour operation, and their liability is limited to the terms of the airline tickets and land accommodation contracts. They are not liable for any delays, inconveniences, accidents, expense, or mishap of any kind whatsoever resulting entirely, or in part, from the negligence of others or from causes beyond their control. They can accept no responsibility for losses or additional expenses due to delay or changes in air or other services, sickness, weather, strike, war, quarantine, or other causes. Losses or expenses will have to be borne by the passenger since tour rates provide for arrangements only for the time stated. Personal travel insurance is strongly recommended. The right is reserved to substitute accommodations or modes of transportation and to make changes in the itinerary when necessary. On tours of this type, it is not possible to accommodate persons with health problems or physical disabilities which limit walking or other activities. One must assume the risks inherent in foreign travel to less developed areas of the world. It is the passenger's responsibility to judge the appropriateness of these travel activities in conjunction with his/her physician. The New York Botanical Garden and affiliates take no responsibility for special arrangements or problems incurred by passengers physically unable to participate in planned activities, or with special dietary needs. No refund can be made for absence from the tour. The right is reserved to decline to accept or to retain any person as a tour member for any reason which affects the operation of the tour or the rights and welfare or enjoyment of the other tour members. The price of the tour is based on current tariffs and exchange rates and is subject to adjustment in the event of any change therein. Baggage is at the owner's risk entirely. If the entire program must be canceled, participants shall have no claim other than for a full refund.

(Please sign above)

EMERGENCY CONTACT:

Name: ___________________________________________________

Address: _________________________________________________

Phone: Daytime: ( ) ______________________

Evening: ( ) _____________________________

E-mail: ________________________________