Performing Arts Medicine Association | Cuba Registration 2019

Full Name (as on passport) *

E-mail *

Telephone *

Cell Phone *

Fax

Home Address *

City *

State *

State Other...

Country *

Postal Code *

Birth Date *

Month

Day

Year

Birth Place *

Mother’s Maiden Name *

Gender *

Female

Male

Citizenship *

Passport Number *

Passport Expiration Date *

Month

Day

Year

If not a U.S. citizen, # of Alien Registration Card or Visa

Alien Registration Card or Visa Expiration Date

Month

Day

Year

Do you speak Spanish?

Yes

No

Other...

Do you speak Spanish? Other...

Emergency Contact Number *

Have you traveled to Cuba before?

Yes

No

If yes, when and for how long?

Vegetarian or other dietary requirements or restrictions

Room Type *

Single Room

Double Room

If selecting a double room, please indicate with whom you will be sharing

OR, select this box if you would like assistance finding a roommate

Help me find a roommate

BIOGRAPHICAL DATA

Name *

Degree(s) *

Write NONE if you do not have a degree

Occupation and Position *

Please provide a short summary of your professional background and interests that relate to the Health and Safety in the Arts in Cuba. *

DEPOSIT:

Requests for arrangements to Cuba require a 50% deposit (based on the room you are reserving). This deposit is due by December 1, 2018. The balance will be due upon recept of your invoice. Once you click the SUBMIT button on this form, you will be able to make your 50% deposit using our secure connection.

CANCELLATION AND REFUND POLICY:

Programs to Cuba are subject to the following cancellation charges if you cancel for any reason:

If your notice is received by December 14, 2018, you will receive a full refund of your deposit.

If your notice is received after December 14, 2018, you will not be eligible for a refund

Above charges do not include cancellation charges imposed by the airlines for any connecting flights to/from your point of departure to Cuba. Nor do they include air tickets from Mexican, Canadian or other cities to Havana bought on a non-refundable basis. PAMA accepts no responsibility for the issuance or denial of licenses by the Office of Foreign Assets Control nor for the issuance or denial of visas by Cuba.

Cuba Registration 2019

People to People Delegation to Cuba: Health and Safety in the Arts

February 3-10, 2019

BIOGRAPHICAL DATA

DEPOSIT:

CANCELLATION AND REFUND POLICY:

Cuba Registration 2019

People to People Delegation to Cuba: Health and Safety in the Arts

February 3-10, 2019

BIOGRAPHICAL DATA

DEPOSIT:

CANCELLATION AND REFUND POLICY:

Search this website