Name Required Address Required Email Required Telephone Number Required Dates Attending Required ----June 22 - July 7, 2018June 22 - June 28, 2018June 29 - July 7, 2018 Release from Liability Required I, and my heirs, in consideration of my participation in the trip to Salvador, Bahia, Brazil, hereby release Mamadêlê Productions,and any other people officially connected with this trip, from any and all liability for damage to or loss of personal property, sickness or injury from whatever source, legal entanglements, imprisonment, death, or loss of money, which might occur while participating in this trip to Brazil. I am aware of the risks of participation, which include, but are not limited to, the possibility of sprained muscles and ligaments, broken bones and fatigue. I understand that participation in this program is strictly voluntary and I freely chose to participate. I understand that Mamadêlê Productions does not provide medical coverage or insurance of any sort for me. Mamadêlê Productions will not be responsible for acts of third parties with whom Mamadêlê Productions has contracted to provide services to participants including but not limited to airlines, other transportation providers, providers of food, tour operators, instructors, performers or guides.