REGISTRATION FORM

Please complete this form and return it with a money order in Euros to Culture Capsules, 9118 West Third Street, Beverly Hills, California 90210. If further information is required, please call Culture Capsules at 310-276-6828, fax the inquiry to 310-205-9011, or visit our web site at www.culturecapsules.com

Each Culture Capsules program is limited to 10 participants. This allows you to enjoy the highest standard of civilized travel and personal attention. Jacqueline Gilbertson accompanies you throughout the journey.

Name____________________________________________________

Address___________________________________________________

City___________________State/Country_________ ZipCode________

Telephone/Fax/Email________________________________________

Please indicate the Culture Capsules journey and date__________________

Please specify any special requests ________________________________

For those clients who prefer a customized program, Culture Capsules will arrange an itinerary to address your particular interests.

TERMS AND CONDITIONS

I. The fee for each program abroad includes luxury, five-star hotel accommodations, transfers between the airport and your hotel upon arrival and departure, all local transportation, all entrance fees, lectures, gratuities, receptions and other specified meals. A deposit of 2,000 Euros per person is required to reserve your place for each program. The balance is due 90 days prior to the first day of the program. Cancellations made more than 90 days prior to the first day of the program will receive a refund less 250 Euros per person administrative charge. If cancellations are made less than 90 days prior to the first day of the program, no refund will be made. Culture Capsules strongly recommends the purchase of trip cancellation insurance.We advise against the purchase of non-refundable airline tickets as we cannot be responsible for any losses resulting from unused tickets.

II.

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In the unlikely event that Culture Capsules cancels the program, a full refund of any payments made will be issued, and this shall constitute full settlement. Culture Capsules reserves the right to cancel any program for any reason. Occasionally, it may be necessary to modify an itinerary; however, any changes will not affect the quality of the program.

I/we agree to the terms and conditions set forth and understand that Culture Capsules will send a release form which must be signed and returned prior to the date of the program.

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Signature Date