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* 1. You must have a passport that does not expire before 1 Oct 2024.  In order for your registration to be complete, you need to send a scan or closeup digital photo of your passport (open to the page with your photo and personal data, with all information legible) to MMaher@SaintChristopherJourneys.com.  If you do not have a passport, you need to send a scan of your passport application.  This is used to purchase your air ticket, which must match your passport exactly.  If you have a non-US passport, you also need to send a scan or closeup digital photo of your green card or US visa.

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* 2. In order for your registration to be complete, you need to send a closeup digital photo of yourself (that really looks like you) to MMaher@SaintChristopherJourneys.com.  This is only used in case of an emergency.  Please do not worry about having a "great picture."  Just a recent, accurate photo is fine (a snapshot from a phone for example).

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* 3. Please carefully read the "Waiver and Release" available on the "forms" page at SaintChristopherJourneys.com.  Do you agree with the waiver and release? https://saintchristopherjourneys.com/forms.html

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* 4. Please carefully read the "Code of Conduct" available on the "forms" page at SaintChristopherJourneys.com.  Do you agree with the Code of Conduct?https://saintchristopherjourneys.com/forms.html

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* 5. Please carefully read the "Crisis Management Plan" available on the "forms" page at SaintChristopherJourneys.com.  https://saintchristopherjourneys.com/forms.html

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* 6. I understand that my permission to travel to Cuba under US law requires my full time participation in group activities.

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* 7. I understand that all payments are non-refundable and non-transferable.  I also understand that the final fee for the journey may increase due to unexpected increases in airfare, especially if the group falls below 13 travelers.  The $675 fee for airfare and preparation services must be paid as a check made out to "Saint Christopher Journeys" and delivered to Lara Wasner in 339 Briggs on the McNichols Campus, OR may be paid through Zelle to Michael Maher at MichaelJMaherJr@yahoo.com.  If not enough participants have been recruited for the journey by the initial deadline and the journey is canceled, I will be reimbursed my payments.

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* 8. First Name:

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* 9. Last Name:

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* 10. Date of Birth.  This is used to purchase your airline ticket.

Date

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* 11. Gender as it appears on the passport you will be using.  This is used to purchase your airline ticket.  It is required that the gender indicated on the passport you will be using to board the plane matches the gender on your airline ticket.

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* 13. Your Cell Phone Number

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* 14. Your mailing address, including zip code:

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* 15. The name of your health insurance company (If you do not have health insurance, just write “none.” Travel insurance may provide some limited health coverage.)

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* 16. Phone number of your health insurance company (If you do not have health insurance, just write "N/A")

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* 17. Your health insurance policy number (If you do not have health insurance, just write "N/A")

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* 18. Your health insurance group number, if applicable:

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* 19. Name of the primary insured person on your health insurance (if you do not have health insurance, just write "N/A")

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* 20. We are collecting medical information from you.  It is completely optional for you to share this information.  If you have a serious medical condition, we encourage you to wear jewelry that indicates your condition and needs.  We compile this information and provide it to your group leader, your host organization (usually a university or church) and possibly with organizations at the destination you are visiting.  While we handle your information carefully, our handling does not meet HIPAA standards for confidentiality.  Again, this is optional.  Do you have any medical conditions that would be important to know in case of an emergency, and that you would like to share with us?

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* 21. We are collecting medical information from you.  It is completely optional for you to share this information.  If you have a serious medical condition, we encourage you to wear jewelry that indicates your condition and needs.  We compile this information and provide it to your group leader, your host organization (usually a university or church) and possibly with organizations at the destination you are visiting.  While we handle your information carefully, our handling does not meet HIPAA standards for confidentiality.  Again, this is optional.  If you would like, please share a list of medications you anticipate that you will be taking while on your journey.

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* 22. Do you have any special dietary needs?

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* 23. Do you have any special needs that would be helpful to know in planning your travel?

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* 24. Name of a person not traveling with you who we should contact in case of an emergency:

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* 26. Phone number of the person to contact in case of an emergency:

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* 27. If you would like to provide a second emergency contact (of a person not traveling with you), please provide their name, email address, and phone number.

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* 28. Do you prefer window or aisle?  We cannot promise anything on seat assignments, and some people will be seated in middle seats.

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* 29. As part of your signing and consent, please provide today's date

Date

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* 30. Signature: Please type out your full name as a form of electronic signature:

T