Registration Form Company Please fill out the form below, acknowledge the terms, choose your room type, and make a payment. First Name * Last Name * Address line 1 * Address line 2 City * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZIP * Phone * Email Address * Emergency contact info: Name, phone, and email. Trip Terms and Conditions Registration Availability is on a first come first served basis. You can secure a spot with a deposit. Deposit A non-refundable $500 deposit will secure a reservation and signify your acceptance of these terms and conditions. Final Payment Due Dates Final payment is due 75 days prior to the start of the trip, on July 1. Failure to make the full payment will forfeit your reservation. Refunds No refunds will be made for failure to attend the trip. Cancelation Policy In the event the tour is canceled, all funds, including the deposit, will be returned within 30 days. Itinerary The itinerary may change due to conditions beyond our control. Media Waiver Photos and video may be made during our trip which we may use for future promotion. If you do not want to be included, initial here: Media Opt-out Initial to opt-out Limitation of Liability You agree that Robert Scheifer or anyone associated with roamingitaly.com or any Italian partners involved in this trip are not responsible and that you will not hold responsible for any personal injury, theft, loss of property, accidents, delays in travel, strikes, health-related problems, or natural disasters during the trip. Acceptance of Terms and Conditions Please sign your name in the box to acknowledge agreement with these terms and conditions listed above: Accept Terms * Enter your name to accept the terms: Room Type * Double Occupancy $3000 per person Single Occupancy $3300 per person Select your room type Roommate If double occupancy, who are you sharing with?