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Jan Yatsko, Artist email: For those people who wish to contact me through email, please see the note on my Contact Page. |
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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?
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