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ACEER
Itinerary and Registration Form |
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Sponsored by the ACEER Foundation, the
Amazon Conservation Association and West Chester University of PA
Orchids of
Peru
November 5th – 14th,
2009
Cost: $3,670 From Lima based on double
occupancy
(International Airfare NOT included)
Deadline for Registration and $500
Deposit: August 3rd, 2009
Visit the Manu
Cloud Forest at Wayqechas, the Sacred City of Machu Picchu, and nurseries in
Lima
Day
01 USA/LIMA
Thursday, 5 November
Travel from USA to Lima, each guest is met upon arrival
in Lima and transferred to the Hotel Sonesta Posada Del Inca, El Olivar.
In-flight meals
Overnight Lima – Hotel Sonesta Posada Del Inca, El Olivar
Day
02 LIMA to
WAYQECHAS Friday, 6 November
After breakfast, transfer to Lima airport for the
flight to Cusco. The bus and guide meet you at the airport in Cusco, the
oldest continuously inhabited city in the western hemisphere. A
distinguishing feature of the city is the colonial Spanish architecture
built upon the foundations of ancient Incan temples. A four hour journey
takes you from Cusco through the Andes Mountains, to Wayqechas. Upon
arrival at the site, there will be a short orientation of the site before
dinner. There will be a short lecture after dinner. The lecture will focus
on orchid species of the cloud forest, with special attention to those found
in the Wayqechas region.
Breakfast at Hotel Sonesta Posada
Del Inca, El Olivar; Box lunch along the way
Dinner and overnight at the Manu Cloud Forest - Wayqechas Lodge
Day 03 Full Day
at MANU CLOUD FOREST - WAYQECHAS Saturday, 7 November
The day will be spent exploring the site and trails.
This site, from top to bottom, straddles 7 climate zones. Where the Andes
meet the Amazon, an avalanche of biodiversity marks the birthplace of the
world’s greatest river. It starts as a trickle of snowmelt on the 20,000
foot peaks of southeastern Peru, swells into a mountain torrent through the
Altiplano and cloud forests, and reaches the sweltering lowlands as a great,
meandering tributary of the Amazon. The site provides an unparalleled
opportunity to see a wide variety of orchids and rare indigenous plants and
animals in this cloud forest environment. After breakfast, the morning will
be spent with your Orchid guide, who will lead a fairly rugged hike from the
lodge, along the Spectacled Bear Trail and along some orchid transects,
where it is possible to see a diverse variety of orchids.
After lunch at the lodge, the group will go to the Manu Cloud Forest
Observatory, the only canopy walkway system in the cloud forests of the
Andes. This is a unique opportunity to view the forest canopy and species
of orchids that grow in the treetops. Return will be at sunset. Or, you may
choose to visit other trails at Wayqechas or just relax in the afternoon.
Breakfast/Lunch/Dinner – Wayqechas Lodge
Overnight – Wayqechas Lodge
Day
04 MANU CLOUD FOREST – WAYQECHAS TO YUCAY Sunday, 8
November
You will enjoy sunrise over the Amazon Basin, the
world’s largest wilderness. From the lodge site, looking eastward, you will
see the Madre de Dios River. In the words of Aldo Leopold, “and ever since
some maps of South America have shown a short heavy line running eastward
beyond the Andes, a river without a beginning and without an end, and
labeled it the River of the Mother of God. That short heavy line … has
always seemed the perfect symbol of the Unknown Places of the earth.” You
depart from the site after breakfast and travel over a magnificent mountain
pass and descend into the Sacred Valley. Along the way you will stop to
have a boxed lunch. If time permits, you will stop at the market in Pisac.
After arriving in Yucay, you will have the afternoon on your own to relax or
explore the small town.
Breakfast: Manu Cloud Forest – Wayqechas Lodge; Lunch: Box Lunch; Dinner:
Casona Yucay
Overnight: Casona Yucay
Day 05
YUCAY to MACHU PICCHU Monday, 9 November
After breakfast, you
depart at 6:45 am and travel through the historic Urubamba Valley to
Ollantaytambo, where you transfer to the train that goes to Machu Picchu,
the Lost City of the Incas. After the hour and a half ride you arrive at
Aguas Calientes (Machu Picchu Village). You check in at the
Pueblo Hotel, where according to the American Orchid Society, the grounds
surrounding the hotel contain the world’s largest native species orchid
garden that is open to the public, 155 native bird species, 15 species of
hummingbirds, 108 butterfly species, and more than 200 species of trees.
After lunch you will join Inkaterra’s experienced orchid guide and
resident biologist, Carmen Soto, for a two to three hour
walk along the hotel's paths. Walk through the orchid garden to observe some
of the hotel's 372 different orchids in bloom. Discover this extraordinary
plant family, which has captured the human imagination for centuries. From
the largest orchid flower in the world – the Phragmipedium caudatum,
to tiny flowering specimens properly appreciated only through a magnifying
glass, there are orchids to amaze both the newly inquisitive and the expert,
including species new to science which have been discovered on the hotel
grounds.
Breakfast: Casona Yucay; Lunch: Inkaterra Cafe; Dinner: Pueblo Hotel
Overnight: Pueblo Hotel
Day 06
MACHU PICCHU Tuesday, 10 November
After an early
breakfast at the hotel, the group will depart between 6 and 6:30 am for the
journey to Machu Picchu to view the sunrise. The topography, geology and
hydrology of Machu Picchu create nine life zones and contain a wide
diversity of flora and fauna species. There are more than 1000 species of
orchids within the Sanctuary, as well as a wide variety of ferns, begonias,
palms, and bromeliads. The Sanctuary has many species of fauna as well
including the solitary eagle, the Andean condor, the ocelot, spectacled
bear, and a great variety of birds including the cock-of-the-rock, Peru’s
national bird. Begin an exploration of the architectural remains of
plazas, palaces, temples, homes, cemeteries and more than 100 irrigated
terraces that formed the structure for the Incan agricultural system. The
day will provide an ongoing opportunity for discussions of Incan cultural
traditions including their agricultural and medicinal practices.
After lunch you may hike from Machu Picchu to the Sun Gate – where the
famous Inca Trail enters the Machu Picchu Sanctuary. Along the way you can
see Epidendrums, Lycastes, Sobralias, and perhaps a Phragmipedium caudatum.
The views of the Sanctuary from the Sun Gate are framed by mountains all
around.
On your return journey from Machu Picchu, there will be an optional visit to
the INC museum and gardens. It does require a 20 minute walk along the
railway to get to and from the museum. Those choosing not to visit the
museum and gardens will return to the Pueblo Hotel. Dinner will be at the
hotel.
Breakfast: Pueblo Hotel; Lunch: Sanctuary Lodge; Dinner: Pueblo Hotel
Overnight: Pueblo Hotel
Day 07 MACHU PICCHU TO
CUSCO Wednesday, 11 November
After breakfast, you will have time to relax or take a
stroll around the grounds of the Pueblo Hotel before boarding the 10:32 am
train and arriving in Ollantaytambo at 12:10 pm, where you will be met and
transferred to a bus for the drive to Cusco. Lunch will be at a local
restaurant in the Sacred Valley. On the way to Cusco you will tour the
textiles galleria and see local artisans weaving wool from alpacas and
llamas and creating traditional woven rugs and clothing. In the afternoon,
we will stop at the ruins of Sacsayhuaman, high above Cusco. You arrive in
Cusco to the Hotel Monasterio in time for dinner.
Breakfast: Pueblo Hotel; Lunch: Local restaurant; Dinner: Hotel
Monasterio
Overnight: Hotel Monasterio
Day 08
CUSCO
Thursday, 12 November
After breakfast, there will be a walking tour of the
main squares of Cusco, the Cathedral and nearby churches. If time permits,
you will visit the local market four blocks away. Lunch will be on your
own. Shopping on your own and an afternoon of leisure. Dinner at a local
restaurant. Night at Monasterio.
Breakfast at Hotel Monasterio; Lunch: On your own;
Dinner: At a local restaurant
Overnight – Hotel Monasterio
Day 09
CUSCO to LIMA
Friday, 13 November
After breakfast you will have the morning on your own.
You depart for the airport for your flight from Cusco to Lima. You go
directly to the Centro de Jardineria Manrique – laboratory and nursery in
Lima, owned by Alfredo Manrique. Mr. Manrique will give you a guided tour
of his nurseries, where you will have the opportunity to see many varieties
not available in the USA. Program at the Centro de Jardineria Manrique:
After the program, you go to an early dinner at Rosa
Nautica – a restaurant on a pier in the Pacific Ocean, before your late
night flights to the USA.
Breakfast at the Hotel Monasterio; Lunch: On your own at the airport;
Dinner at Rosa Nautica Restaurant in Lima
Overnight in flight to the
USA
Day 10
ARRIVAL IN THE USA Saturday,
14 November
International flights arrive in US.
Please Note – Advice for Travelers:
Location/Terrain/Hikes: this workshop takes place in the Andes Mountains.
Elevations range from 8,000 – 12,000 feet. Travelers may experience
problems with altitude sickness. Walking/Hiking will produce shortness of
breath. Trails at Wayqechas are rugged and steep – travelers must wear good
hiking boots and be prepared for fairly strenuous walking.
Road Travel: the roads to Wayqechas are narrow dirt
roads - steep mountain passes, over high elevations.
Lodgings: 4 – 5 star hotels are used, other than at
Wayqechas, which is a research station in the cloud forests of the Andes.
Accommodations at Wayqechas are in unheated cabins, 4 persons (same gender)
sharing one bathroom. Warm clothing and raingear are required.
Instructors and Guest Lecturers Biographical
Information
Carmen Rosa Soto Vargas
Carmen Soto Vargas is a native of Peru and from the
city of Cusco. Carmen graduated from the School of Biological Sciences,
National University of San Antonio Abad in Cusco (UNSAAC.) She learned to
identify and love orchids in Inkaterra Machu Picchu Pueblo Hotel, where she
has worked almost 10 years for Inkaterra Association as resident Chief
Biologist in charge of flora conservation projects (orchids, ferns and
flowers in general,) fauna (Spectacled Bears, butterflies and wild birds
management) and in situ research.
Alfredo Manrique
An Agronomist from Universidad Agraria la
Molina, Lima Peru, Alfredo Manrique started
Centro de Jardinería Manrique a nursery business in 1972. At that
time he focused mainly on Conifers, Azaleas, and Begonias. In the beginning
he did not grow orchids, but in the early ‘90s Alfredo discovered the high
potential of adding orchids to his business, especially with the great
interest for Peruvian species. He then changed the emphasis to orchids and
now 90 percent of his business is dedicated to them. Alfredo’s nursery is
considered to be among the best in Peru. Growers from all over the world
visit his facilities and purchase his plants and seedlings. The nursery
keeps 20,000 mature plants and 10,000 seedlings of different species and
hybrids in stock. With the help of late Dr Isaias Rolando, a well known
orchidist and member of the Peruvian Orchid Society, Alfredo started his own
in-vitro lab. The lab began operations in 1995 and now produces more than
1000 flasks annually.
Alfredo has been a grower and hibridizer of Peruvian
orchids since 1988, and has been growing and hibridizing Phragmipedium
kovachii since 2003. He has been a member of the Peruvian Orchid Society
since 1994, where he was president from 2001-2005, and a member of the
American Orchid Society since 1996. Alfredo attends many orchid shows,
mainly in the USA, where he has been invited to speak at many of them due to
his extensive knowledge of Peruvian orchids. Recently he has spoken at the
National Capital Orchid Society, Baltimore, Orchid Society, Harrisburg
Orchid Society, Maryland Orchid Society, the Coalition of Orchids species in
Miami, the Winter Orchid Fair in Miami, the Redland Orchid fair in Miami and
the New York Orchid Society. Alfredo has also spoken to the Andean Orchid
Conference and Quito Orchid Conference and at the 19th World Orchid
Congress in Miami.
Alfredo still has the first orchid that entered his
collection of ornamental plants in the 80´s. A Cattleya maxima, that he was
not able to put in bloom for 6 years until he moved it to an area that
received higher light.
Alfredo may be
reached at:
cjmgard@terra.com.pe
Websites of interest:
www.peruorchids.com/en/index.html
http://www.phragmipediumkovachi.com
www.perucjmorchids.com
For more information about the tour, please contact the
ACEER Foundation and visit our website:
www.aceer.org.
Contact: Mary Ann Robinson
mrobinson@wcupa.edu
610-738-0477
Total Cost: $3,670 all inclusive from Lima (Peruvian
air, hotels, food, transportation, guide service, entrance fees.)
International airfare will be purchased by the traveler and is NOT included
in the total cost. $500 Deposit and registration forms are due by August 3,
2009. Final payment of balance is due September 2, 2009. Mail forms and
checks to:
The ACEER Foundation; PO Box 2549 – WCU; West Chester, PA 19383 |
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ACEER
FOUNDATION
RESERVATION CERTIFICATE
Please enclose a check for $500 per person deposit August 3rd,
2009 to reserve space(s) on the departure date designated below.
Workshop price is per person based on double occupancy.
I would like to participate in the following Workshop:
Orchids of Peru; November 5th – 14th,
2009
($3,670 from Lima)
DUE TO THE VOLATILITY
OF FUEL PRICES, TRAVELERS WILL BE CHARGED ANY ADDITIONAL FEES LEVIED BY THE
AIRLINES PRIOR TO TICKETING.
NAME (S) Dr. ___ Mr. ___ Mrs. ___ Ms. ___
(Print full name as it appears on passport for each traveler.)
Address
City
State Zip
Home Phone
Business Phone
Fax
e-mail
Phone number(s) prior to departure
ACCOMMODATIONS
I would like to share a room with
Please assign a roommate. Yes ___ No ___
I desire single accommodations (Land portion only; single accommodations are
available for an additional charge of $900.00).
Yes ___ No ___
How did you hear about this workshop:
___________________________________________________________
METHOD OF PAYMENT
FINAL payment due by
check prior to departure date – FINAL
PAYMENT DUE Sept. 2nd, 2009
Please address checks to:
ACEER Foundation; P.O. Box 2549 -WCU; West Chester, PA
19383
INSURANCE
The ACEER Foundation
REQUIRES travelers to obtain Travel
Insurance in case of trip delays, flight cancellations, luggage coverage,
and health related issues. Some insurance Companies include pre-existing
medical conditions.
Contact your travel agent, or ACEER, or go to
WWW.TRAVELGUARD.COM.
Please attach proof of insurances to this document. Trip insurance is
required. Please list name of company providing coverage and policy number:
____________________________________________________________________________________________________________
I have received,
read and accept the conditions of the General Information section,
especially the Cancellation clause and the Responsibilities and Conditions
paragraph on this form. I would like to make reservations for the person(s)
listed above in accordance with the enclosed deposit. EACH
PARTICIPANT MUST SIGN THIS WAIVER.
Date
Signature
CANCELLATION POLICY:
All cancellations must be made in writing and are effective upon receipt in
our office.
The following fees apply and are per person:
$100 from time of booking to 90 days prior to departure
$350 from 89 to 61 days prior to departure
Full penalty from 60 to 0 days prior to departure
TRANSFERS: Are subject to the same terms
as cancellations
RESPONSIBILITIES, TERMS AND CONDITIONS:
The ACEER Foundation , its affiliates and agencies (hereafter referred as
THEY) act only in the capacity of agents in all matters
Of transportation and tour operation, and
their liability is limited to the terms of the airline tickets and land
accommodation contracts. THEY are not liable for any delays, inconveniences,
accidents, expenses, or mishaps of any kind whatsoever resulting entirely,
or in part, from the negligence of others or from causes beyond their
control. THEY can accept no responsibility for losses or additional expenses
due to delays or changes in air or other services, sickness, weather,
strike, war, quarantine, or other causes. All such losses or expenses will
be borne by the passenger, as tour rate provides for arrangements only for
the time stated. The right is reserved to substitute accommodations or modes
of transportation and to make any changes in the itinerary where deemed
necessary or caused in changes in air schedules. On expeditions of this type
it is not possible to accommodate persons with severe health problems or
physical disabilities which involve walking or other activities. It is the
passenger’s responsibility to judge the appropriateness of these travel
activities to their physical capabilities. THEY take no responsibility for
special arrangements or problems incurred by passengers physically unable to
participate in the planned activities. No refund can be made for absence
from the tour unless arrangements are made at the time of booking. The right
is reserved to decline to accept or retain any person as a tour member for
any reason which affects the operation of the tour or the rights and welfare
or enjoyment of the other tour members. THEY will not discriminate against
any individual because of race, sex, creed or nationality. A refund of the
cost of recoverable land tour services is the limit of the ACEER Foundation
and its affiliates’ liability. All contracts for services provided by the
ACEER Foundation and its affiliates are entered into the state of
Pennsylvania and all parties to such contracts submit to the exclusive
jurisdiction of the courts of the state of Pennsylvania.
PERSONAL DATA FOR
TRAVEL DOCUMENTS
Please complete the following information for each person.
Name
Nickname
Date of Birth
Age
Nationality
Passport Number
Occupation
________________________________________________________________________________
T-shirt size for ACEER t-shirt: (S, M, L, XL, XXL) _________________
Emergency contact person _________________________ Phone
Number_____________________________
Relationship __________________________
Please
specify dietary and physical
needs:________________________________________________________
____________________________________________________________________________________________________________
RELEASE
OF LIABILITY PRIVATE
I,
_______________________________(full name), as a participant of the
Orchids of peru workshop
to Peru sponsored by the Amazon Center for Environmental Education and
Research (ACEER)
Foundation and
Centro Amazonico de
Educacion Ambiental e Investigacion (Fundacion
ACEER),
fully release the Amazon Center for
Environmental Education and Research (ACEER) Foundation and Centro
Amazonico de Educacion Ambiental e Investigacion (Fundacion
ACEER)
from all liability for any delays,
inconveniences, accidents, expenses, or mishaps of any kind whatsoever. I
understand they can accept no responsibility for losses or expenses due to
delays, changes in air or other services, sickness, accidents, weather,
strike, war, quarantine, or other causes. All such losses or expenses will
be borne by me. Accordingly, and in consideration of my participation, I
hereby agree to the following:
I have read the
information herein and recognize and accept any risks thereof. I understand,
and hereby agree, on behalf of myself, my dependents, heirs, executors and
assigns, to abide by the conditions set forth in this Release of Liability
and hereby release and hold harmless the Amazon Center for Environmental
Education and Research (ACEER) Foundation,
Centro Amazonico de
Educacion Ambiental e Investigacion (Fundacion
ACEER),
and any of its directors, officers,
employees, agents, licensees or representatives from any and all liability
arising out of or relating to my participation, however occurring, including
injuries, death, delays, cancellation or loss or damage to property.
Dates of Travel
November 5th – 14th, 2009
Guest Full Name
(print) _____________________________________
Signed
_____________________________________
Signed by Parent (if
app.) _____________________________________
Dated
_____________________________________
Each guest must submit an original copy of this signed form to the ACEER
Foundation.
ACEER FOUNDATION
RECOGNITION OF RISK
The following agreements are designed to protect all
workshop participants in the ACEER Foundation Workshops to Peru:
participants, students, faculty, its trustees, officers, agents and
employees, and the agencies and individuals cooperating with the ACEER
Foundation. We require all workshop participants (and their parents if
under 21) sign these forms to indicate their agreement and permission.
If a participant has a history of any medical or
psychiatric problems during the previous two years, we strongly advise that
he/she consult with a medical professional in this country before departure
to discuss the potential stress and difficulty of travel abroad.
- I/We understand that participation in the program
is entirely voluntary and that any program of travel involves some
element of risk. I/We agree that in partial consideration of ACEER
sponsoring this activity, I/we will hold the ACEER Foundation, its
trustees, officers, agents, and employees harmless from any damages for
any injury or loss to persons or property the participant might sustain
while so participating. I/We hereby release the ACEER Foundation, its
trustees, officers, agents and employees from any liability whatsoever
for any personal injury (including death) or property damage arising
from participation in the program. I/We agree to the “Release of
Liability” document which is executed along with this document, and I/we
agree to indemnify the ACEER Foundation, its trustees, offices, agents
and employees from and against any loss or claim arising from my
participation in the program.
- I/We understand that
the ACEER Foundation or the sponsoring institution reserves the right to
make cancellations, changes or substitutions in case of emergency or
changed conditions or in the interest of the group. Should the ACEER
Foundation cancel the program, full refunds will be made unless the
cancellation is due to political, natural, technological or other
catastrophes beyond its control in which case the ACEER Foundation will
be able to refund only uncommitted or recoverable funds. Should another
sponsoring institution cancel its program, its refund policy, if any,
will apply.
- I/We understand that participants in the program
are representatives of the ACEER Foundation and the United States and by
signing this agreement pledges to deport himself or herself in a manner
that reflects favorably on both. We understand that in addition to
regular classes the program may include planned lectures and field trips
which are germane to the educational experience, and that the
participant agrees to participate willingly in such activities in
addition to regular classes.
- I/We understand that the ACEER Foundation requires
that appropriate sickness and accident insurance cover all participants
for the duration of the program, and that they be financially
responsible for all medical expenses. In addition, we understand that
payment for medical expenses customarily will have to be advanced, and
reimbursement sought later from the carrier.
INSURANCE IS REQUIRED FOR PARTICIPATION IN
THIS WORKSHOP
Name:______________________________________________________________________________
is
insured under policy number ____________________ with (name of insurance
company)
______________________________________________. The policy expires on
__________________.
In
addition, the traveler hereby assumes responsibility for all medical
expenses incurred by and on behalf of the traveler while participating
in the program.
5. I/We understand
that foreign programs may not regularly employ health care professionals
overseas and make no representation with respect to accessibility of
services and facilities abroad. Appropriate treatments, especially
psychological, may not be as readily available abroad as in the United
States. The participant must, therefore, make provision before
departure for continuation of medical treatments such as prescriptions
or special diets. The director of the program should be fully informed
of any special needs before leaving on the program.
- For a participant under the age of 18 years, if
ACEER is unable to reach a parent or guardian to give consent, I/we, the
parent(s) or guardian(s) of the above named participant hereby authorize
the ACEER Foundation’s representative to consent for me/us to any x-ray
examination, anesthetic, medicinal or surgical diagnosis, or treatment
and hospital care deemed necessary or advisable by a physician during
the period the participant is enrolled in the ACEER Foundation program.
- For a participant who is 18 years of age or older,
if I/we are unconscious or otherwise unable to give my/our consent, I/we
hereby authorize the ACEER Foundation’s representative to consent for
me/us to any x-ray examination, anesthetic, medicinal or surgical
diagnosis, or treatment and hospital care deemed necessary or advisable
by a physician during the period the participant is enrolled in the
ACEER Foundation program.
- It is understood that the authorizations listed
above are given in advance of any specific diagnosis, treatment or
hospital care being required but are given to provide authority and
power on the part of the ACEER Foundation to give specific consent to
the diagnosis, treatment or hospital care which in the best judgment of
a physician is deemed advisable.
I/we authorize all health care
providers or other covered entities to disclose to ACEER or ACEER’s
representative, upon request, any information, oral or written, regarding my
physical or mental health, including, but not limited to, medical and
hospital records and what is otherwise private, privileged, protected or
personal health information such as health information defined and described
in the Health Insurance Portability and Accountability Act of 1996
(“HIPAA”), the regulations promulgated thereunder, and any other federal,
state or local laws and rules.
SIGNATURES
The signatures of both the participant and their parent
or legal guardian are required (if under age 21). Please return this form
(three pages) completed with your registration form.
Your registration is
not complete without this signed document.
Student/Workshop Participant:
I certify
that I have read the entire preceding agreement, and I join in the
articles of the agreement without reservation, granting my consent to
all action herein.
Signature____________________________________________________ Date
____________________
Parent/Guardian:
I certify
that I am the parent or legal guardian of the student named above; that
I have read the entire preceding agreement, and I join in the articles
of the agreement without reservation, granting my consent to all actions
herein.
Signature____________________________________________________ Date
____________________
Print
Name _________________________________________ Phone ___________
Email____________
Address
______________________________________________________________________________
Street
City State Zip code
ACEER
Foundation Photo Release Form
I grant
permission to the ACEER Foundation and its agents or employees, to use
photographs taken of me for use in ACEER publications, both printed and
electronic. I hereby waive any right to inspect or approve the finished
photographs or printed or electronic matter that may be used in conjunction
with them now or in the future, whether that use is known to me or unknown,
and I waive any right to royalties or other compensation arising from or
related to the use of the photograph. I hereby agree to release, defend and
hold harmless the ACEER Foundation and its agents or employees, including
any firm publishing and/or distributing the finished product in whole or in
part, whether on paper or via electronic media, from and against any claims,
damages or liability arising from or related to the use of the photographs,
including but not limited to any misuse, distortion, blurring, alteration,
optical illusion or use in composite form, either intentionally or
otherwise, that may occur or be produced in taking, processing, reduction or
production of the finished product, its publication or distribution. It is
the discretion of the ACEER Foundation to decide whether to use the image.
I am 18 years of
age or older and I am competent to contract in my own name. I have read this
release before signing below, and I fully understand the contents, meaning
and impact of this release. I understand that I am free to address any
specific questions regarding this release by submitting those questions in
writing prior to signing, and I agree that my failure to do so will be
interpreted as a free and knowledgeable acceptance of the terms of this
release.
________________________________________________________________
Name (please print)
________________________________________________________________
Signature
________________________________________________________________
Signature of guardian [if under 18 years of age]
________________________________________________________________
Date
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