EmailMe Form - R3 Retreat Registration

Name *

First Last

Date of Birth *

MM / DD / YYYY

Email *

Phone *

### - ### - ####

Departure Airport *

T-Shirt Size

How did you hear about this retreat?

What are you hoping to gain from the retreat experience?

Travel Information 1/30/20-2/2/20

Retreat accommodations will be at the Hideaway at Royalton Negil in Negril, Jamaica. Retreat package includes all-inclusive resort, flight, airport transfers, and all retreat activities. Base price is based on double-occupancy in junior suite ocean view room.

Room Style

Junior Suite Ocean View

Junior Suite Swim Out (semi-private pool connected)

Room Type

Single

Double

Roommate Name

Need a roommate match?

Yes

No

Disclosures and Payment Information

Would you like to add cancel for any reason travel protection for $90.99 per person? *

Yes

No

All passengers in room must select protection in order for any to add.

By signing here I acknowledge that I must have a valid passport to travel to Jamaica. Please see https://travel.state.gov/content/travel/en/international-travel/International-Travel-Country-Information-Pages/Jamaica.html for additional details. *

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By signing here I acknowledge that deposits are non-refundable and final payments for this trip are due on, or before, 12/1/19. I also acknowledge that late payments will be charged a $25 per person fee for late payments up to 3 days late and $5 per day after 3 days. *

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Change/Cancellation Disclosure and Consent
4 Simplicity Sake LLC charges a $50 cancellation fee and a $25 change fee to all packages, in ADDITION to any supplier fees, unless otherwise noted in writing. Cancellation fees must be paid via online link before cancellations, and any due refunds, can be processed.

We make every effort to honor the package price quoted originally, however; under certain circumstances your price may be subject to increase prior to full payment due to an increase in the cost for one or more of the travel components of your package.

Prices will not increase after you make full payment, except for charges resulting from increases in government-imposed taxes or fees. *Cruiselines have a right to charge a fuel surcharge, per their policies.

By signing below, you expressly acknowledge your acceptance of these conditions applicable to your purchase.

http://airconsumer.dot.gov/rules/EAPP_2_FAQ_01-11-2012final.pdf

By signing here I indicate that I have been advised of potential change/cancellation charges that may be implemented in the event that I choose to cancel or change my booking after making the initial deposit. *

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Cardholder

First Last

Payment Method *

Billing Address *

Street Address City State / Province / Region Postal / Zip Code

Card Number *

Expiration Date *

MM / YY

3 Digit CVV/CVC Code *

4 digits for AMEX users

Card Holder Authorization: I, the above-named authorized credit card user, give 4 Simplicity Sake LLC and its representative express authorization to charge my credit card for the purposes detailed above. I understand that this form constitutes a legally binding contract and that by affixing my signature to this form, I will be held responsible for all agreed upon (as stated above) charges as well as any and all collection and legal fees. By signing this "Credit Card Authorization" form, I/my organization acknowledge receipt and understanding of its contents, including its "Explicit Authorization" clause. 4 Simplicity Sake assumes no responsibility for changes made to a reservation if the payment fails to process. I am also acknowledging that I am the cardholder held under penalty of law

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