HHR Registration - Long Form

Hayner Hits the Road Registration Form

You are registering for a Hayner Hits the Road trip.

First we need to know a bit about you.

* Indicates required field

Your Name *

First

Last

Email *

Best Phone Number *

Additional Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Now we need some information about the trip. Which trip are you registering for? *

How are you planning to make your payment? *

Online (you will be directed there when you hit the submit button.) I will mail a check. I will stop in the Hayner and make a payment.

How much will you be paying at this time? *

If you are paying by credit card, what is the name on the credit card? *

Do you prefer one bed or two? *

One bed Two beds It does not matter to me at all

Please let us know who you would like to room with: *

Emergency Contact Information: Now we need for you to provide information about someone who is not traveling with you that can be an emergency contact *

First

Last

Emergency Contact Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact Phone Number *

I hereby agree to release, discharge and hold harmless The Troy-Hayner Cultural Center and trip hosts from any and all liability or damages that may occur during my participation on the trip. The Troy-Hayner Cultural Center and trip hosts do not assume responsibility for the actions or the non-action of our tour operators, their employees, or their agents. Therefore, The Troy-Hayner Cultural Center and trip hosts are neither responsible to participants for any loss, damage, or injury, financial or otherwise, during or in connection with the trip to and from or while at the destination. I fully assume all risks associated with the utilization of and participation in the trip listed above. *

I have read and agree to the terms above. I do not agree to the terms outlined above.

Submit