The Trip Price is $2395 for double occupancy, based on 6 participants and a euro/dollar conversion rate of $1.30.

To reserve a place, please complete and return the first page of this Enrollment Form with your check for $1000. Room assignments will be made in the order of enrollments.  

The Final Trip Payment will be due on August 26, 2012.

CANCELLATION, REFUNDS AND PENALTIES
In the event of cancellation by Chez Madelaine, participants will be offered a full refund of their prepayments.

Cancellation by Participant
In the event of cancellation by a participant, the Deposit of $1000 will be non-refundable UNLESS A REPLACEMENT CAN BE FOUND.  It is highly recommended that participants obtain Trip Insurance for protection against cancellation and cancellation penalties.

RESPONSIBILITY:

Chez Madelaine is acting only as agent for trip participants and assumes no liability for personal injury, loss, property damage, accident, or delay arising out of the acts of default of any carrier, hotel, motor coach, or other persons rendering any services in connection with the trip.  Baggage is at owner’s risk.  No refund will be made for any unused portion of the trip.

Chez Madelaine is not responsible for failure or delay in performance arising from causes beyond its reasonable control.  It can accept no responsibility for loss or expense due to sickness, weather, strike, war, acts of terrorism, quarantine, or other causes beyond its control.  Every effort will be made to adhere to the printed program; however, it may be necessary to make such alterations to the program as are necessary under circumstances beyond the control of the Chez Madelaine for the benefit of the trip participants.

By completing and signing the trip application form, the participant agrees to the terms and conditions of the trip and agrees to waive all claims and suits against, defend, release and hold Chez Madelaine harmless for any and all liability for personal injury, property damage or loss of any nature whatsoever arising from participation in this trip program.




Please send your signed and completed enrollment form and deposit  to Chez Madelaine, 425 Woodside Ave., Hinsdale, IL  60521 and retain a copy of this enrollment form for your records.  Please direct all trip inquiries to Madelaine Bullwinkel  at 630-514-8712  or This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Participant Information
Name as it appears on your passport
_______________________________________________________________________
Address:
_______________________________________________________________________                                                                                                                                                     
Street                          City                      State           Zip Code                                                    
_______________________________________________________________________
Home Phone                 Cell                    email

I am requesting (check one): [    ] single [     ]  double occupancy* with

_________________________________________________
(Please submit a separate enrollment form for each participant in Double Occupancy)

___    My deposit fee for $1000, made payable to Chez Madelaine is enclosed.
___    I wish to charge the $1000 deposit fee to my credit card, plus an additional 4% card  processing charge .

CARD NUMBER ____________________ Expires:_____   CODE ______

MY SIGNATURE INDICATES THAT I have read and agree to all of the following Terms and Conditions of this travel program.

SIGNATURE ________________________________    DATE:____________