Jan Yatsko, Artist email:

janyatsko@racsa.co.cr

janyatsko@ice.co.cr

For those people who wish to contact me through email, please see the note on my Contact Page. 

BuiltWithNOF
Registration Form

   Please register me for the following tour:

EXPLORE & CREATE IN COSTA RICA ART WORKSHOP/TOUR                                   JULY 2-10, 2011                     

___Double room @ $1,575 (Only available if sharing a room with a travel companion)

I would like to share a room with_____________________________________

___Single room @ $1,950

Please mail this completed and signed form to:   Jan Yatsko, Explore & Create in Costa Rica, #SJO 19310, PO Box 025331, Miami, FL   33102-5331.

DEADLINE:  May 2, 2011

Please print

Name__________________________________________ M / F (circle)

Address______________________________________________________

City_____________________________State_________Zip______________

Day phone___________________

Night phone_______________________

Email_________________________

Emergency phone_________________

Contact name____________________________________

Waiver of liability: All registered participants in the Explore & Create Costa Rica Tour agree to assume all risk for personal injury or loss of or damage to personal property and further agree that they will not hold Jan or Tom Yatsko responsible or liable for any personal injuries that may be suffered, death or theft of or damage to any personal property that may occur. Participants accept all conditions of  registration, payment and cancellation.

I understand and accept the waiver of liability.

Signature _______________________________ Date _____________

Dietary/Medical restrictions__________________________________________

Where did you find out about this trip? ____________________

Briefly describe your interests, art/craft skills and level. What do you hope to learn during this trip?