Phone: (417) 451-5468 | Email:
EACH PARTICIPANT MUST PRINT AND COMPLETE:
I, _____________________________________________, hereby agree that I am participating in the Advantage Club Travel Program. In doing so, I agree to comply with all of the rules and regulations which are outlined in both printed materials distributed and with verbal instructions given by the Advantage Club Travel Program.
While a participant in the Advantage Club Travel Program, I assume all responsibility for my own safety, health, and physical ability to participate on each tour. On behalf of myself, my heirs, personal representatives, and executers, I hereby indemnify, release and hold harmless the Advantage Club Travel Program, GalaxSea Cruises & Tours, and Community Bank & Trust, including their directors, employees and agents from any and all claims, damages and liability, including, but not limited to, any claims of personal injury and property damage and any accidental or consequential damages arising from my participation in the program.
I have read and agree to the conditions stated above.
Name (Please Print)_______________________________________________________________________________
Signature of Parent or Guardian if participant is under the age of 18:
Date of Birth if participant is a minor (month, date, year) _________________________________________________
Please return to Tom Higdon with Community Bank & Trust
PO Box 400, Neosho, MO 64850
OR to GalaxSea Cruises & Tours, 210 N Business 49, Neosho, MO 64850