Participant Registration: Credit Card

Personal Information

Email Address*

Participants Name (as it appears on passport) First, Middle, Last*

Sex* Male Female

Date Of Birth*

Home Address (Street, City, State, Zip Code)*

Use Google Smart Search for Address

Address 1:

City:

Country:

State/Province:

Postal Code:

Mobile Phone Number (xxx)xxx-xxxx* - -

Allergies*

Physical Restrictions ie. Wheelchair Access, Assistive Devices

Name of Employer*

Occupation

How did you hear about ACES International?

Travel Information

Passport Number*

Passport Issue Date*

Passport Expiration Date*

Country of Issue*

Special Flight/Hotel Amenities (Added Expense) *SINGLE HOTEL ROOM ACCOMODATES 1 PARTCIPANT. **

Name of Preferred Roommate- 2 Participants per hotel room-* PARTICIPANTS WITH PREFERRED ROOMATE DO NOT SELECT SINGLE HOTEL ROOM OPTION ABOVE**

Emergency Contact Information

Emergency Contact Information: First and Last Name*

Emergency Contact Information Relation to Participant*

Emergency Contact Information Primary Phone* - -

Emergency Contact Information Secondary Phone - -

Payment Due Dates

Cancelation/Refund Policies

• 30% penalty of remaining balance if cancelation notice is received between 60 days and second installment (November 15, 2024) prior to the travel departure date.
• 50% penalty of remaining balance if cancelation notice is given within 45-59 days prior to the travel departure date.
• 80% penalty of remaining balance if cancelation notice is given within 30-44 days prior to the travel departure date.
• No refund is available when the cancelation notice is received within 29 days of notice before the travel departure date.

Participant and Release Agreement

(Please Click the Link)* I Agree

Amount (1.5% Credit Card Surcharge fee included) $5,785.50

Payment Method:*

Payment Notes/Additional Info:

Name on Card:*

Email You Want Associated with Credit Card Payment:*

Card Number:*