Jay Maldi Maa Temple Chicago

4N256 IL RT 83, Bensenville, IL 60106

maldimaatemple@gmail.com

Tel: 630-530-0623 or Contact: Nick Patel 630-600-8293

Shree Maldi Mataji Madir, Bensenville, IL/ Jun 30- July 03, 2016

Yatra to Siva Vishnu Temple, Lanham, MD

Registration Form

First Name: _____________________________________

Middle Name: __________________________________

Last Name: _____________________________________

Address:   ______________________________________

City: __________________________________________

State: ____________________ Zip Code: _____________

Tel: _____________________ Cell: __________________

Work: ___________________ Other: _______________

E-mail: ________________________________________

Life Member         Member              Non-Member    

       (Name) Attendees 18 & Over                            Age

Registration and Rules & Regulations for Travel and Lodging

1. This request for registration is made subject to the terms and conditions of the Agreement to Release and Indemnify included in this document. Please read this entire document carefully. All registrants must sign the Agreement to Release and Indemnify.Registration cannot be confirmed until your deposit is received and the Agreement to Release and Indemnify is signed. Registration and/or attendance imply agreement with the terms and conditions of the Agreement to Release and Indemnify included in this document.

2. Subject to and provided registrant(s) abide by the terms contained herein, Jay Maldi Ma Temple will provide transportation to and from Lanham, Maryland for purposes of visiting the Siva Vishnu Temple (hereinafter called the “Temple Bus Trip”).

3. Subject to and provided registrant(s) abides by the terms contained herein, Jay Maldi Maa Temple will bear the cost of lodging for properly registered individuals, but for only those persons who register early. Those registered after Jan 1, 2016 will be liable for their own lodging expenses and will remain responsible for all costs associated with the event. Jay Maldi Maa Temple will not bear the costs of lodging for any dates except July 1, 2016 and July 2, 2016.

4. Jay Maldi Maa Temple retains exclusive and sole discretion in choosing the lodging provider and all related activities thereto.

5. Room Reservation forms must be returned to Jay Maldi Maa Temple by July 1, 2016.

6. Lodging will be provided only on July 1, 2016 and July 2, 2016; additional lodging may be available by request, subject to additional cost.

7. All occupants in each room must provide their name and residential address.

8. All rooms must be kept clean and orderly.

9. Everyone is expected to stay inside and not loiter in the lobby or parking area.

1. All keys must be returned at check out on July 03, 2016 before coming to the Mandir (Temple) by 9:00 a.m.

1. No parties or big gatherings are allowed on the hotel property.

2. Room service will not be provided during your stay. Any person who orders room service shall be responsible for all costs associated with same.

3. Registrant(s) shall remain liable for any and all damages incurred during their stay, including, but not limited to charges levied by the lodging provider.

AGREEMENT TO RELEASE AND INDEMNIFY

TOUR: Jay Maldi Maa Temple (Chicago) to Sri Siva Vishnu Temple (Lanham, Maryland)

Dates: June 30 to July 04, 2016

NAME(S):_____________________________________________________________________

NAME(S):_____________________________________________________________________

NAME(S):_____________________________________________________________________

NAME(S):_____________________________________________________________________

NAME(S):_____________________________________________________________________

For and in consideration of Jay Maldi Maa Temple’s agreement to permit me to participate in the Temple Bus Trip, and for all related activities thereto, I agree as follows:

1. I understand that tour prices can very due to supplier charges, currency fluctuations, parking fees, and other increased costs and that the cost of this tour is subject to change to reflect such variations.


2. I understand that certain risks are inherent in the activities to be undertaken by me /us, including but not limited to risks related to long distance travel, and I accept and assume full responsibility for those risks.


3. I further understand that certain inherent risks exist, such as inclement weather, acts of God, or outbreaks of war, and I accept and assume full responsibility for such specified inherent risks and those not specifically identified.


4. I, individually, and on behalf of my heirs, successors, assigns and personal representatives, hereby release and forever discharge Jay Maldi Maa Temple and its employees, agents, officers, directors, trustees, attorneys, and representatives from any and all liability whatsoever (excluding liability arising directly from the gross negligence and willful misconduct of Jay Maldi Maa Temple) for any and all damages, losses or injuries (including death) I sustain to my person or property or both, including but not limited to any claims, demands, actions, causes of action, judgments, damages, expenses and costs, including attorneys’ fees, which arise out of, result from, occur during, or are in any way connected, directly or indirectly, with my participation in the Temple Bus Trip, or any travel or lodging incident thereto.


5. I, individually, and on behalf of my heirs, successors, assigns and personal representatives, hereby agree to indemnify, defend and hold harmless Jay Maldi Maa Temple and its employees, agents, officers, directors, trustees, attorneys, and representatives from any and all liability (including all liability arising directly or indirectly from the negligence of Jay Maldi Maa Temple or its employees, agents, officers, trustees, governors or representatives), loss, damage or expense, including attorneys’ fees, which arise out of, occur during or are in any way connected, directly or indirectly, with my participation in the Temple Bus Trip, or any travel or lodging incident thereto.


6. I represent and warrant that I will be covered throughout the Temple Bus Trip, and any travel and lodging incident thereto, by my own and/or my parents’ health insurance. I understand that it is my responsibility to obtain and pay for health insurance. In the event of my injury, I authorize the Jay Maldi Maa Temple representative to secure whatever treatment is deemed necessary by an attending physician. I agree to reimburse Jay Maldi Maa Temple for any medical costs advanced on my behalf.


7. I understand and agree that Jay Maldi Maa Temple has no liability for my personal medical expenses and/or medical care. I certify that I am good health and physical condition and do not have any physical disability, medical condition or other limiting factor that would create a hazardous situation for myself/us or other passengers.


8. I have read, understand, and accept this Agreement to Release and Indemnify, which contains the entire and final agreement relating to the subject matter hereof. Its term shall be binding on me and my heirs, legal representatives and assigns. I have additionally read, understand, and accept the Rules and Regulations for Travel and Lodging and acknowledge that I will abide by same. I further agree to abide by all rules and instructions of the Jay Maldi Maa Temple or its representatives or agents relating to participation in the Temple Bus Tour and I agree that my failure to observe and obey such rules may result in revocation of the right to participate in any such activities without further recourse.


9. If any provision of this Agreement to Releases and Indemnify is determined to be void, unenforceable, ineffective or against public policy, that provision shall be disregarded and deemed removed from this Agreement to Release and Indemnify and shall not affect the remaining provisions of this Agreement to Release and Indemnify.


10. This agreement to release and indemnify shall be governed by and construed under the laws of the State of Illinois.


11. In signing this document, I hereby acknowledge that I have read this entire document, that I understand its terms, that by signing it I am giving up substantial legal rights I might otherwise have and that I have signed it knowingly and voluntarily.


12. My tendering of this signed form and the tour deposit implies my consent and agreement to the above conditions.

AGREED:

Passenger 1

Signature: __________________________________________________Date:_________________

Print Name: ______________________________________________________________________

Address: ______________________________________________________________________

DOB: ________________________________

Passenger 2

Signature: __________________________________________________Date:_________________

Print Name: ______________________________________________________________________

Address: ______________________________________________________________________

DOB: ________________________________

Passenger 3

Signature: __________________________________________________Date:_________________

Print Name: ______________________________________________________________________

Address: ______________________________________________________________________

DOB: ________________________________

Passenger 4

Signature: __________________________________________________Date:_________________

Print Name: ______________________________________________________________________

Address: ______________________________________________________________________

DOB: ________________________________