REGISTRATION FORM. Registration Forms & $200 Deposit due -> October 9, 2016

Transcription

1 Northwest University College of Business T H E I M P E R I A L C I T I E S Budapest, Vienna and Prague I N T E R N A T I O N A L B U S I N E S S T O U R M a y 9-1 9, REGISTRATION FORM REGISTRATION FORM: Please complete all information on the following pages of the registration form. This information is necessary to reserve and guarantee your place in the program. Cover sheet Explanation of pages in registration form. Registration sheet (page 1) Agreement to Student Code of Conduct (page 2) Deposit payment sheet (page 3). Release of Liability sheet (page 4)- sign and return at time of registration Personal Data (page 5) complete and return at time of registration Cost for Travel Tour: $ Deposit plus $ Course Fee Registration Forms & $200 Deposit due -> October 9, 2016 **Please bring your deposit to Nedra Gannon s office in the College of Business** PAYMENT ARRANGEMENTS: Checks should be made out to Northwest University. Financial Aid may be used toward the tour fee if remaining funds are available after tuition has been paid. Any balance remaining may be used for educationrelated expenses. Cancellation Policy $200 deposit is non-refundable No refunds after course DROP period has expired. Waiting List: The first 30 Eligible students who register and pay the deposit will be guaranteed a place on the trip. Others will be placed on a waiting list. Northwest University will not be held liable if a program has to be cancelled due to circumstances beyond our control.

2 THE IMPERIAL CITIES International Business Tour S T U D E N T R E G I S T R A T I O N T H E I M P E R I A L C I T I E S International Business Study Tour ( P L E A S E F I L L O U T F O R M C O M P L E T E L Y ) Student Name: Address or Campus Box: City: State: Zip: Phone Home: Work: Cell: Student ID #: Student Birthdate: STUDENT STATUS Check one: Sophomore Junior Senior Academic Credit What course are you enrolling for: (Separate course registration is also required) BUSM 4123 BMGT xxx3 International Business 3 credit International HR Management 3 credits R E G I S T R A T I O N F O R C O U R S E C R E D I T Tuition registration and fees are separate from International Study Tour fees/expense.

3 T H E I M P E R I A L C I T I E S International Business Tour Agreement to Student Code of Conduct I u n d e r s t a n d a n d a g r e e : I w i l l c o m p l y w i t h t h e N o r t h w e s t U n i v e r s i t y S t u d e n t C o d e o f C o n d u c t a s d e s c r i b e d i n t h e s t u d e n t h a n d b o o k. T h a t a l c o h o l, t o b a c c o a n d r e c r e a t i o n a l d r u g s a r e n o t a l l o w e d i n a n y f o r m. I w i l l b e r e s p o n s i b l e f o r m y o w n b e l o n g i n g s a t a l l t i m e s. I w i l l a c t r e s p o n s i b l y a n d c o u r t e o u s l y a s a r e p r e s e n t a t i v e o f N o r t h w e s t U n i v e r s i t y. I w i l l a c t r e s p o n s i b l y a n d c o u r t e o u s l y t o w a r d m y o t h e r t r a v e l t e a m m e m b e r s. I w i l l r e s p e c t a n d a b i d e b y t h e d i r e c t i o n o f N o r t h w e s t U n i v e r s i t y f a c u l t y l e a d i n g t h e p r o g r a m. T h a t a n y d e v i a t i o n f r o m t h i s C o d e o f C o n d u c t m a y r e s u l t i n t h e t e r m i n a t i o n o f m y p a r t i c i p a t i o n i n t h e p r o g r a m, i n c l u d i n g b e i n g s e n t h o m e a t m y o w n e x p e n s e. Student/Participant (printed name): (Signature) (Date)

4 3 D E P O S I T P A Y M E N T D U E O N O C T O B E R 9, NAME Enclosed is my deposit payment of $ in the form of: CHECK in the amount of CREDIT CARD # VISA MasterCard Other (Specify) On, (date) I authorize the amount of $ deposit Name on card Expiration date Signature Date

5 4 RELEASE OF LIABILITY NORTHWEST UNIVERSITY College of Business 2016 THE IMPERIAL CITIES International Business Tour I have voluntarily chosen to participate in the Northwest University College of Business International Business Tour on May 9-19, I understand that the purpose of this Release of Liability form is to protect Northwest University and its governing board, agents and employees (collectively the University ) from any and all liability which may arise from, or be related to, my participation in this International Tour. I acknowledge and understand that there are certain dangers and risks inherent in travel and the activities included in the Tour, and that the University cannot and does not assume responsibility for losses including, but not limited to, personal injuries or property damage arising therefrom. These risks may include losses regarding travel to and from a destination; the condition of the facilities included in the tour; criminal activity; the defect of a vehicle or the negligence of Tour service providers; sickness, weather, strikes, hostilities, wars, natural disasters, or other such causes; and any disruption of travel arrangements, or any additional expenses that may be incurred therefrom. I acknowledge and understand that the University does not represent, or act as an agent for, the transportation carriers, facilities, or their suppliers of services in connection with the Tour. Knowing the dangers and risks of such activities, and in consideration of being part of the Tour, I, on behalf of my family, heirs, and personal representative(s), agree to assume all risks and responsibilities surrounding my participation in the Tour and release and forever discharge, waive, and covenant not to sue the University from and against any and all liability for any harm, injury, damage, claims, demands, actions, causes of action, costs, and expenses of any nature whatsoever which I may have, or which may hereafter accrue to me, arising out of or related to my participation in the Tour. I agree to hold the University harmless from and against any claim by me or my family arising out of my participation in the Tour. I further agree that this release shall be governed and interpreted in accordance with the laws of the State of Washington. I release the University, its officer, directors, employees, and agents ( the University ), from all claims and liabilities of any kind, including, but not limited to, claims based on the negligence of the University (either individually or collectively), related to or arising from my participation in the International study tour. This release is binding on me and my personal representative and heirs. I have carefully read this document and understand what it says. T H I S I S A R E L E A S E O F L E G A L R I G H T S P L E A S E B E C E R T A I N Y O U U N D E R S T A N D T H I S D O C U M E N T B E F O R E S I G N I N G I T. Student/Participant: (Printed name): (Signature) (Date)

6 5 P E R S O N A L D A T A PLEASE FILL OUT FORM COMPLETELY AND RETURN WITH REGISTRATION. YOUR RESERVATION CANNOT BE CONFIRMED WITHOUT THIS COMPLETED FORM. NAME: PASSPORT #: ISSUED BY: (COUNTRY) COPY OF PASSPORT IF YOU DO NOT HAVE A PASSPORT YOU SHOULD OBTAIN ONE IMMEDIATELY. OBTAINING A VALID PASSPORT IS THE STUDENT S RESPONSIBILITY AND NOT HAVING ONE BY TIME OF TRAVEL WILL RESULT IN LOSS OF PAYMENTS MADE. IN CASE OF EMERGENCY PLEASE NOTIFY: CONTACT NAME: ADDRESS: PHONE NUMBER: CELL PHONE NUMBER: DIETARY AND MEDICAL RESTRICITONS PLEASE LIST ALL DIETARY RESTRICTIONS, SEVERE ALLERGIES AND MEDICAL CONDITIONS WE SHOULD BE AWARE OF: