Name: ____________________________________________________ Date of Birth: __________________

Address:_____________________________________City:_________________Postal Code:_____________

Home phone:(____)________-___________Cell:(____)______-___________ Work: (____)______-_________

Email: __________________________________________________ Fax: (____)______-___________

How did you hear about the singles travel club? ____________________________________

Areas of interest: Please tick all areas of interest:

Trips of interest to me:
_________________________________________________________________________________

Preferred Accommodations: Budget
Non-smoking Smoking __________ Snore Yes No __________Late riser Early riser

Trip Cost ........ Under $1000 ........ $1000-$2500 ........ Over $2500 ....... Depends on trip

RELEASE / WAIVER – PLEASE READ CAREFULLY

I hereby certify that I am nineteen years of age or older and I agree to abide by the rules and regulations of the Singles Travel Club and Jubilee Tours & Travel Ltd. and to participate in the events and activities sponsored by the Single Travel Club and Jubilee Tours & Travel Ltd. in accordance with the rules, regulations and by-laws.

In consideration of the Single Travel Club and Jubilee Tours & Travel Ltd. accepting me as a member and my being permitted to take part in its events and activities, I hereby, for myself and my heirs, executors, administrators and assigns, hereby forever release, discharge and hold harmless the Single Travel Club and Jubilee Tours & Travel Ltd. their directors, officers, representatives and agents for any injury, loss or damage to my person or property howsoever caused, arising out of or in connection with my taking part in the set events and activities and notwithstanding that the same may have been contributed to or occasioned by the negligence of the Singles Travel Club or Jubilee Tours & Travel Ltd., its directors, officers, representatives or agents. I also give my release to allow use of my picture in photo albums or promotional material.

Applicant’s Signature: ___________________________________ Date: _______________________