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Please tear out along the perforations. You may make copies of this form.
CANCELLATION
POLICY:
For cancellations received
on or before
February 12, 2014, all monies will be
refunded with the exception of the one
hundred dollars ($100.00) per person
deposit. For cancellations
between
February 12, 2014 and February 18,
2014, an additional $100.00 per
person penalty will apply to cover
hotel and entertainment guarantees.
Cancellations received
after
February
18, 2014 will result in a
FULL FORFEITURE
of all monies paid. All cancellations
must be in writing to the UCA
International All Star Championship.
We will not accept cancellations by
phone. Deposits from cancellations
cannot
be applied toward your
balance.
I have read the cancellation policy and
understand and accept its contents. I
have also advised all participants,
parents and chaperones of my group
of this cancellation policy.
________________________________________
Main Contact Signature
____________________________________________
Date
Each adult traveling on the travel
package and each participant’s
parent must sign below. “We have
read the cancellation policy and
understand and accept its contents.”
Your application will not be entered
without all signatures.
______________________________
______________________________
______________________________
______________________________
______________________________
CREDIT CARD PAYMENT:
If any family members wish to charge their deposit or balance of payment on a cred-
it card, we accept VISA, MasterCard, Discover or American Express. Below list the
person wishing to charge, their credit card number, expiration date and amount to
be charged along with their signature. Please send this information along with your
registration.
(One form per family group.)
CREDIT CARD TYPE:
m
VISA
m
MC
m
AMEX
m
DISC
Exp. Date: ___/___/___
Total Amount Charged: $_________________
Account Number:
nnnn nnnn nnnn nnnn
m
Deposit
or
m
Balance of Payment*
Name (Print)
Signature
Billing Address*
Daytime Telephone Number Cell Phone Number
City, State Zip
Email Address
If this credit card payment is not for your entire group, please list
person(s) and amounts to be paid with this credit card.
Person(s)
Amount
1. ________________________________________ ____________
2. ________________________________________ ____________
3. ________________________________________ ____________
4. ________________________________________ ____________
5. ________________________________________ ____________
6. ________________________________________ ____________
7. ________________________________________ ____________
8. ________________________________________ ____________
9. ________________________________________ ____________
10. ________________________________________ ____________
*Please complete this form for each charge (i.e. charge your deposit
in January and then complete another charge form in
February to charge your balance).
Balance of payment due by February 12, 2014.
