*First name:

*Last name:

*Postal address:

*Town/City:

*State/province:

*Post/zip code:

*Country:

*Phone:

*Email address:

*Confirm email address:

*Date of birth: Month 123456789101112   Day 12345678910111213141516171819202122232425262728293031   Year 19971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948 *Age *Male Female

*Country or countries of citizenship:

*Expedition you would like to join (write the title of the Expedition as it appears on the Expedition description page):

For example: “Research methods in international development”

*Expedition start date: Month 123456789101112   Day 12345678910111213141516171819202122232425262728293031   Year 20132014

*Expedition end date:   Month 123456789101112   Day 12345678910111213141516171819202122232425262728293031   Year 20132014

 

*Do you have any special dietary requirements? Yes No
If yes, please provide us with more information.

For example: I am a vegetarian.

*School Type: Secondary/High School Apprenticeship Technical School University Other

*School Name:

*Degree: Diploma Certificate Bachelors Level Master Level Doctorate Level Other * Graduated: Completed In Progress Stopped

Major Area of Concentration:

School Type: Secondary/High School Apprenticeship Technical School University Other

School Name:

Degree: Diploma Certificate Bachelors Level Master Level Doctorate Level Other Graduated: Completed In Progress Stopped

Major Area of Concentration:

Employed: Current employer

Type of Employment: Academic Private Public Government
Job Title:

Employed: Current employer

Type of Employmet: Academic Private Public Government
Job Title:

*Language 1. Level Native Fluent Advanced Intermediate Beginner

Language 2. Level Native Fluent Advanced Intermediate Beginner

Language 3. Level Native Fluent Advanced Intermediate Beginner

Language 4. Level Native Fluent Advanced Intermediate Beginner

*Do you have any medical conditions that we should be aware of? YesNo
Please note: We are not medical professionals and we suggest that before your trip you visit your physician or a travel health clinic to ensure that you are in good enough health for your placement and to obtain any immunizations that may be suggested and/or required.
If yes, please provide us with any information that you think we should be aware of.

*Have you ever been convicted of a crime? YesNo
If yes, please explain the nature of the conviction(s).

*Have you joined a UBELONG program before? YesNo
If yes, when and where?

*Have you been referred to UBELONG by anyone?YesNo
Please note: To learn more about the Share the Good Campaign, see the UBELONG Fund section of our website.
If yes, what is their name and relationship to you?

For example: John Doe, friend.

*How did you hear about us?

*What were the two most important factors to you in deciding to join a UBELONG Expedition?

*What do you expect from your experience on a UBELONG Expedition? (100 words maximum)

Do you have any additional information that you would like us to consider? (100 words maximum)

TERMS AND CONDITIONS

PLEASE READ CAREFULLY.
THIS IS A LEGAL DOCUMENT THAT AFFECTS YOUR LEGAL RIGHTS. By signing this Agreement, you are accepting and acknowledging the terms and conditions set forth.

You, * , accept and acknowledge the terms and conditions set forth in this Agreement as they relate to your voluntary participation in an Immersion or Expedition program arranged by UBELONG (from now on in this Agreement referred to as "we", "our" or "us").

 

1. Personal risk
You accept and acknowledge that travel to a developing foreign country and/or remote area involves inherent risks and dangers, including, but not limited to:

Accommodations;

Roads;

Trails;

The maintenance or operation of any vehicle utilized to transport passengers;

Transportation failures whether by airplane, train, auto, boat or other watercraft, horseback or other animal, by foot or by any other conveyance;

Risks associated with food or impure water;

Consumption of alcoholic beverages;

Dangers associated with wild or other animals;

Physical exertion;

Stolen, lost or misplaced property;

High altitude;

Forces of nature;

Civil unrest;

Acts of terrorism;

Accident or illness in remote regions without means of rapid evacuation or availability of medical supplies and facilities;

Adequacy of medical attention once provided.

 

You accept and acknowledge that personal injury or illness, emotional trauma, property damage and death can occur by natural causes or activities of persons or animals, either as a result of negligence or because of other reasons.

 

If you are accepted into the placement that you are now applying for, prior to us confirming your placement we will ask you to read, agree and sign our liability waiver that, amongst other things:

 

Releases us, our owners, our employees and any persons or groups associated to us of all liability;

Signifies that you are waiving any claims against us, our owners, our employees and any persons or groups associated to us, and expressly assuming all risks associated with participating in any of our programs.

2. Insurance

For all of our programs we require that you have travel medical insurance, including emergency evacuation, throughout your experience.

For our Immersion placements we do not include it because there are many different plans available and you know best what is right for you. Before your departure we will ask you for general information about your policy, but it is your sole responsibility to determine its adequacy and any associated details like coverage levels and deductibles. If you fail to provide us with the requested insurance information within 10 days of your start date, you will lose your spot and your fees will not be refunded.

For our Expeditions we include travel medical insurance, as it is more practical from a risk management perspective if the entire team has the same insurance carrier since the team will be travelling as one.

 

3. Cancelation and refund policy

General

We reserve the right to revise the placement and project fees at any time. Changes will be made via our website and with at least seven days advance notice. If you have already submitted your application and not yet begun your placement you will be held to the original pricing.

Placement Fee

The US$200 placement fee is refundable only up to 60 days before the start date of your placement. If you change your start date, the earliest date is used for refund purposes. To request a refund, you must send a signed letter to our Washington , DC office or email a scanned signed letter to us indicating that you are requesting a refund. The date of your refund request is the date that your letter is received at our offices or in our email.

 

Upon receiving your letter we will send you an acknowledgement email. If you do not receive an email, assume that we have not received your letter. All refunds will be made less a 20% processing fee. Placement fees are not transferable to another person. If you sign-up within 60 days of your placement, the placement fee is not refundable.

 

The placement fee is due within 48 hours of receiving your acceptance letter. If we do not receive the placement fee, your placement will not be confirmed and you may need to reapply.

 

Program Fee

The program fee is refundable only up to 60 days before the start date of your placement. If you change your start date, the earliest date is used for refund purposes. To request a refund, you must send a signed letter to our Washington , DC office or email a scanned signed letter to us indicating that you are requesting a refund. The date of your refund request is the date that your letter is received at our offices or in our email.

 

Upon receiving your letter we will send you an acknowledgement email. If you do not receive an email, assume that we have not received your letter. All refunds will be made less a 20% processing fee. Program fees are not transferable to another person. If you sign-up within 60 days of your placement, the program fee is not refundable.

 

If the start date of your placement is more than 60 days away, then the program fee is due at least 60 days before your start date. If we do not receive the program fee, you may lose your placement and we will not refund you the US$200 placement fee.

 

If the start date of your placement is less than 60 days away, then the program fee is due within 48 hours of receiving your confirmation letter. If we do not receive the program fee, you may lose your placement and we will not refund you the US$200 placement fee.

 

Switch Fee (applicable to the Immersion program only)

Within the city, town or reserve that you originally signed-up for you can request to switch projects at any time (for example, if you want to switch from teaching English in Lima to women's empowerment in Lima). However, we may ask you to submit a new application to ensure you meet the project's participation requirements and we do not guarantee there will be an available position for you. There is no fee to switch projects within a city, town or reserve that you originally signed-up for.

 

To change the city, town or reserve that you originally signed-up for you can request to switch projects at least 45 days before your start date (for example, if you want to switch from a project in Lima to a project in Cusco). If you change your start date, the earliest date is used. W e may ask you to submit a new application to ensure you meet the project's participation requirements and we do not guarantee there will be an available position for you. If we determine that you can make the switch, there is a US$25 switch fee payable to us within 48 hours of receiving your switch confirmation letter. If we do not receive the switch fee, you may lose both your original and new placements and we will not refund you your placement and/or program fee if your start date is less than 60 days away.

 

4. Immunization and travel health

While we may offer you a list of suggested immunizations and travel health tips based on such publicly available sources as the United States Center for Disease Control and World Health Organization, we are not medical professionals and have no medical expertise whatsoever. We strongly recommend that you visit a medical professional before your trip; however, it is your sole responsibility to arrange and determine any required immunizations and medical procedures that you may need before, during and after your placement.

 

Furthermore, you accept and acknowledge that we have no responsibility regarding the adequacy of any evacuation plan and medical care, equipment or supplies that may be provided to you before, during or after your placement. You are solely responsible for your own welfare, and you accept and acknowledge any and all risks of personal injury or illness, emotional trauma, property damage and death that may occur as a result of your placement with us.

 

5. Travel to your program country

You are responsible for arranging and paying all your airfare and other transport to and from the country where you will be joining one of our programs. While we may offer you travel advice, it is your sole responsibility to arrive in your host country in a comfortable, safe and timely manner.

 

Additionally, start and end dates are fixed. If you arrive late to your placement or miss days during your placement, regardless of the reason, we will not reimburse you. If you stay extra days, either before or after the placement period that you signed up for, you will be charged for the additional days at a rate determined by us.

 

6. Travel within your program country

Unless explicitly noted by us in the description of your placement (for example, we offer airport pickup on many of our Immersion projects), you are responsible for arranging and paying for any local transportation that you may need or wish to use. While we may offer you travel advice, it is your sole responsibility to use sound judgment and travel in a comfortable, safe and timely manner.

 

7. Immigration

While we may offer you advice on such immigration issues as passports and visas, immigration laws and policies are constantly changing and vary greatly across countries. You are solely responsible for planning your entry and departure from foreign countries and carrying the necessary documents. We are not liable for any cost, whether financial or otherwise, that you may incur in attempting to enter or leave a country.

 

8. Local partners

You accept and acknowledge that we organize, promote and offer programs that offer accommodation, transportation and other services provided by our local partners.

If you are accepted into the program that you are now applying for, prior to us confirming your placement we will ask you to read, agree and sign our liability waiver that, amongst other things, releases us, our owners, our employees and any persons or groups associated to us of all liability related to:

 

Any of our local partners´ negligent or willful acts, or failures to act including, without limitation, their partial or complete failure to deliver services to you;

Any personal injury or illness, emotional trauma, property damage or death which arises out of any service provided to you by our local partners;

Any error, misrepresentation or mistake, whether intentional or unintentional, made by any of our local partners.

 

9. Participant acceptance

To join any of our programs there is an application form that you must complete and submit. We reserve the right not to accept you into a program for any reason.

 

Additionally, we rely upon any statements or representations that you make in the application form or during the application process as being true.

 

10. Code of conduct

If you are accepted into the placement that you are now applying for, prior to us confirming your placement we will ask you to read, agree and sign our code of conduct. The document details our expectations of you as they relate to you joining our programs.

 

It is our sole right to determine violations of the code. If at any time during your placement we feel that you are not abiding by the code, we reserve the sole right to ask you to leave. You will not be reimbursed for the remaining balance of your stay.

 

11. Guarantees and warranties

The information on our site is provided "as is" without any representation or warranty, express or implied, of any kind, including, but not limited to warranties of merchantability or fitness of any kind.

 

Furthermore, all of our materials, including but not limited to, our website, may contain inaccuracies and typographical errors. We do not warrant the accuracy, completeness or reliability of any advice, material, opinion, statement or other information displayed or distributed through our materials. You accept and acknowledge that any reliance on advice, material, opinion, statement or other information that we provide to you shall be at your sole risk.

 

Finally, we reserve the sole right to make any changes to any of our materials, including but not limited to, prices, privacy policy, programs and terms of services, at any time and without notice.

 

12. Attorney fees

You agree that in any litigation, arbitration or other proceeding arising from or related to this Agreement, the prevailing party shall be entitled to recover from the non-prevailing party all reasonable attorney fees and associated costs and expenses incurred. In the event of a non-adjudicative settlement of litigation between the parties or a resolution of dispute by arbitration, the term "prevailing party" shall be determined by that process.

 

13. Governing law

This Agreement is governed by the laws of District of Columbia in the United States of America . You agree to submit to the exclusive jurisdiction of the courts sitting in the District of Columbia and waive any jurisdictional, venue or inconvenient forum objections to such courts. You expressly agree that this Agreement is intended to be as broad and inclusive as permitted by the laws of the District of Columbia .

 

14. Legally binding

These terms and conditions shall be legally binding upon you, your family, heirs, administrators, executors and legal representatives. In signing this document, you are not relying upon any oral or written representations or statements made by us other than what is set forth in this Agreement. You understand and agree that in the event that any clause or provision of this Agreement is found to be unenforceable or invalid by a court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining clauses and provisions of this Agreement and will be construed as though the unenforceable clause or provision had never been contained in this Agreement.

 

Your electronic signature below certifies that you have carefully read and fully understand the contents of this Agreement. You understand that this is a legally binding and enforceable contract and you are aware of its legal consequences, and have signed it freely and voluntarily, without any inducement, assurance or guarantees that have been made to you. You certify that any statements or representations that you have made are true and you understand that we may rely upon them as true. You intend your electronic signature to be a complete and unconditional acceptance and acknowledgment of all these terms and conditions set forth in this Agreement to the greatest extent allowed by law.

 

 

Electronic Signature: *