Jan Yatsko, Artist email: jan@janyatsko.com

   Please register me for the following tour:

EXPLORE & CREATE IN COSTA RICA ART WORKSHOP/TOUR

 ___ FEBRUARY 2009 TOUR                                      ___ JULY 2009 TOUR                       

___Double room @ $2100 (Only available if sharing a room with a travel companion)

I would like to share a room with_____________________________________

___Single room @ $2375

Please mail this completed and signed form with a single check in dollars payable to Jan Yatsko that totals the above indicated tour price  to:   Jan Yatsko, Explore and Create in Costa Rica, 313 E. Frederick St., Lancaster, PA  17602.

Deadline:  November 20, 2008 for February tour and April 9, 2009 for July tour

Please print

Name__________________________________________ M / F (circle)

Address______________________________________________________

City_____________________________State_________Zip______________

Day phone___________________

Night phone_______________________

Email_________________________

Emergency phone_________________

Contact name____________________________________

Waiver of liability: All registered participants in the Explore and Create Costa Rica Tour agree to assume all risk for personal injury or loss of or damage to personal property and further agree that they will not hold Jan or Tom Yatsko responsible or liable for any personal injuries that may be suffered, death or theft of or damage to any personal property that may occur. Participants accept all conditions of  registration, payment and cancellation.

I understand and accept the waiver of liability.

Signature _______________________________ Date _____________

Dietary/Medical restrictions__________________________________________

Where did you find out about this trip? ____________________

Briefly describe your interests, art/craft skills and level. What do you hope to learn during this trip?