50th Annual General Assembly: The 2017 Interline Celebration
Registration Form
Havana and Varadero, Cuba, 22–27 October 2017
(One Form Per Person)
Name (as in passport, please print) first, middle: last:Nationality: / Passport No:
Passport Date of Issue (day/month/year): / Passport Expiry Date (day/month/year):
Date of Birth (day/month/year): / Gender: Male Female
Attending as: Delegate Observer
Will you be attending the pre-AGA and/or the post-AGA tours: Yes No
If yes, please specify which tour(s):
Will you be attending the optional Catamaran tour: Yes No
Note: A separate registration form(s) must be completed for your pre-AGA and/or post-AGA tour(s).
Will you require an additional night(s): Yes No
If yes, please specify date(s) required (day(s)/month):
Payment: Package Deposit WACA Fee Catamaran Tour
Payment by: Cheque Money Order Bank Draft payable to the World Airlines Clubs Association (not WACA)
Payment by: bank transfer .
Please provide details of your transaction, e.g. bank name, sent by bank transfer/cheque/draft, reference number, amount, etc.:
Tel. No.: Country code () Area code () / E-mail (please print):
Accommodation Required
Double (one double bed) twin (two single beds) single supplement (one bed)
Rooming partner (if applicable): Name (first, last):
Rooming partner request (if applicable): male female
Special Requirements
Please specify any allergies, meal restrictions (vegetarian, no pork, no beef, etc.), mobility limitations:
Intended arrival from:
Date (day/month/year): Flight No.: / Intended departure to:
Date (day/month/year): Flight No.:
Conditions
This is my reservation request for the above package. I have read and understood the package brochure as well as the conditions regarding the payment and cancellation policies, etc. With my signature below I guarantee payment. I also agree that transportation to and from the start point of the package (Havana, Cuba), travel insurance, all legal liability(ies) are entirely my responsibility. The World Airlines Clubs Association shall not be liable for any personal injury, loss, damage, delay, accident, changes to the programme and any other irregularity which may occur during the event.
Participants must accept the conditions above and agree not to take any legal actions against the World Airlines Clubs Association or any of the suppliers of services related to the event.
Signature: ______Date (day/month/year):
Approved by (Interline Club President or Interline Club WACA Representative or WACA Administration Manager):
Name:
Signature: ______Date (day/month/year):