OOPS! You missed it!
This was the Registration Form for the Journey to Pasaquan
 
Print the form below and mail with your check payable to "JMOMA"
 
Space is extremely limited and available on a first-come-first-served basis.
To pay by credit card, you must register in person at JMOMA.
Your Name:
(Please fill out a separate sheet for each individual.)
Mailing Address:
City - State - Zip
Telephone - Home:                                                        E-Mail Address:
                   - Work:
List the name of the person with whom
you'll be sharing a hotel room:
(indicate "None" if you want to have a hotel room by yourself and pay the $50 single supplement.)

Indicate the number of people included in your enclosed payment
in the appropriate boxes below:
     JMOMA Member – per person double occupancy        $189.00
     JMOMA Member – per person single occupancy         $239.00
     Non-Member – per person double occupancy                 $239.00
     Non-Member – per person single occupancy                  $289.00
    TOTAL number of people      Total Amount $ _________

No refunds are available after September 30, 2005.
Responsibility: JMOMA acts only as agent for the participant and exercises every care in making the arrangements listed in the itinerary. We assume no liability for injury, damage, loss, accident, delay or irregularity in connection with services of suppliers. We accept no responsibility for losses or additional expenses due to delay in services, sickness, weather, strike, war, acts of God or nature or any causes beyond our control. Tour rates provide for arrangements only for the time stated. The right is reserved to accept, decline or retain any person as a member of the tour should such person’s health, mental condition, physical infirmity, or general deportment impede, in the tour director’s judgement, the operation of the tour or the rights, welfare or enjoyment of other tour participants. The cost of the trip is quoted as a package and credits are not given for services not used. We reserve the right to make any changes in the itinerary or substitute services of equal value with or without notice if found to be in the best interests of the group as a whole. Members must be in reasonable good health and able to walk moderate distances.
YOUR PAYMENT SIGNIFIES ACCEPTANCE OF THE ABOVE CONDITIONS AND RESPONSIBILITIES AS OUTLINED.

I HAVE READ AND UNDERSTAND THE CONDITIONS OF THE TOUR: Signature ___________________________________

Make check payable to "JMOMA". Send this form with your check to:

JACKSONVILLE MUSEUM OF MODERN ART
333 North Laura St.    Jacksonville, FL   32202

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