PLEASE PRINT CLEARLY Paducah Trip-April 21, 2009 - April 27, 2009 Name……………………………………………………………………………………...... Address…………………………………………………………………………………….. Postal Code………………………………………………………………………………… Roommate………………………………………………………………………………….. Name and Phone # of 2 people in case of emergency ……………………………………………………………………………………………… ……………………………………………………………………………………………… Health concerns…………………………………………………………………………… ……………………………………………………………………………………………… Do you need special seating on the bus? If so why? ……………………………………………………………………………………………… To make entrance into the United States run smoothly I suggest you get a passport. I would also suggest you get health insurance; it is available at most banks, as well as the motor league. A first deposit of $100 is due by August 31, 2008. Second deposit of $300 is due by October 31, 2008 Third Deposit of $300 is due by January 31, 2009 Final payment of $300 is due by February 28, 2009. Refunds will be made: 1. If I can fill your place with someone from a waiting list. 2. If you are able to get someone to fill your place. 3. If the executive decides to cancel the trip you will receive a full refund. 4. If you cancel your seat a $20 cancellation fee will apply. I will not hold the Rouge Valley Guild and its executive responsible for any loss or damages that might occur during this trip. Signature…………………………………………… Please make your cheque out to the Rouge Valley Quilters Guild and mail it along with the application form to Ingrid Jack-Edwards, 1 Meekings Dr., Ajax Ont. L1T 3N9.