DEAF-BLIND ADVENTURE IN FLORIDA

Hosted by DEAF-BLIND EXPLORERS

 with the help of Sibley Biederman at 

        Dan Howell Travel

         1749 Chase Avenue

         Cincinnati, Ohio 45223

Please contact Lynn Jansen for faster service at:

        Email Address: DeafBlindTravel@aol.com

        Telephone Number: 513-242-4171 (Voice)

Fax: 513-242-4287

Mailing Address: Deaf-Blind Explorers, Inc.

                              P.O. Box 32015    

                              Cincinnati, OH  45232-0015

Where:   Disney World, SeaWorld and Swimming with the Dolphins                                       Discovery Cove

Date:    June 20 - 26, 2010, Sunday through Saturday

Price:   $1133.67 - $1502.71 per DBP

              $451.48 – $721.79 per SSP                                    

(See chart below for your preference of price packages)

Deposit Required:  35% deposit is due by February 15, 2010.

Price includes:

w  Welcome Party

w  Six nights at Disney’s All Star Music Resort Hotel

w  Platform and SSP Interpreters

w  Shuttle between hotel and airport

w  Transportation to/from Disney World, SeaWorld and Discovery Cove

w  Tickets, includes:

²  Disney World

w  5 days/ park hopper pass

²  SeaWorld

²  Discovery Cove

w  Breakfast & Lunch

w  Swimming w/dolphins is dependent on choice of price package

Price based on first come, first served, as space will be limited and registration will be taken in the order received. When signing up, please list your SSP or DBP and roommate name(s) on registration form.  Feel free to contact Lynn Jansen if you have any questions about the exact costs. 

Send the completed registration forms (pages 4 – 11) together with your check payable to “D-BE” to:

         Deaf-Blind Explorers

         PO BOX 32015

         Cincinnati, OH  45232-0015

Registrations postmarked after February 15, 2010 will be considered late and will be accepted dependant on availability and will incur a $15.00 late fee. Registrations postmarked after March 22nd will not be accepted.

The price packages are as follows for each DB or SSP individual. This includes six nights at Disney’s All Star Music Resort Hotel, tickets for Disney World, SeaWorld, and Discovery Cove with a choice of with or without swimming with the dolphins:

We require all the DBP to bring his/her own SSP. All SSPs should have experience working with DBP and will require a letter of reference listing experience and training when sending in registration form.

Please Note: You are on your own for transportation to and from Orlando, Florida. If you would like, we can arrange for Sibley, our travel agent, to help you. Also, you are on your own for all meals with the exception of one breakfast and one lunch at Discovery Cove.

Travel insurance will be offered at an additional cost based on the cost of the package that you choose. You will be able to get a quote at booking.  We highly recommend travel insurance, as the future is a very hard thing to predict.

D-BE REGISTRATION FORM

Please answer all questions clearly in black ink. Write N/A if a question does not apply to you. Incomplete forms will be returned.

GENERAL REGISTRATION

_________________________________________________
LAST NAME                               FIRST NAME

________________________________________
NICKNAME

________________________________________________
ADDRESS

________________________________________________
CITY                           STATE/COUNTRY         ZIP CODE

HOME PHONE: _________________________________       

VOICE_____TTY_____

 WORK PHONE: _________________________________

VOICE_____ TTY____­_

 FAX: _________________________________________

E-MAIL:_______________________________________

DATE OF BIRTH: ___________ SEX: ___ M ___ F

Is it okay to list your name and email address on the roster to be passed out before or during our trip? ____ Yes   ____No

Will you be celebrating a special occasion at this time? Please list the occasion   

____________________________________________

____________________________________________

I am registering as:  ____Delegate   ____SSP   ____Interpreter

Print media preference: ___Large Print   ___Braille  ___ Print

VISION — My vision is best described as:
____Tunnel Vision   ____Close/Low Vision   ____Blind
____Sighted   ____Other __________________________________________

HEARING — My hearing is best described as:
____Deaf   ____Hard of Hearing (I use a FM/Loop)
____Hearing   ____Hard of Hearing (I do not use FM/Loop)

Are you a vegetarian?   ____ Yes   ____No

          If so, what type ___________________________

Health, Diet or Mobility needs: ___________________________________________

EMERGENCY CONTACT - In case of emergency please list a person to be contacted:

________________________________________________
NAME                                                       RELATIONSHIP

DAY PHONE ___________________________

                                    VOICE ____ TTY ____

EVENING PHONE_______________________

VOICE ____ TTY ____

HOUSING INFORMATION

I would like to share a room with:________________________________________
(Your roommate(s) should list your name on their registration to guarantee preference.)

Price packages are for double or more occupancy per person.  If you do not have a roommate you will be placed on a waiting list until you can be matched with other(s).  Please indicate if you have a preference for the number of roommates:

____ 1 roommate only      ____ 2 roommates

 ____ 3 roommates            ____ 1, 2, or 3 roommates

                 I am a smoker ____ Yes   ____No

I can share a room with a smoker ____ Yes   ____No

I am bringing my dog guide ____ Yes   ____No

I can share a room with a dog guide user ____ Yes  ____No

(Dog guides must be with you at all times while at Disney)

Do you have any difficulty with stairs? ____ Yes   ____No

Do you have any difficulty walking? ____ Yes   ____No

Do you use a wheelchair? ____ Yes   ____ No

If yes, will you bring your own wheelchair? ____ Yes ___No

TO BE FILLED OUT BY THE DELEGATE ONLY:

SSP PREFERENCES   (NOTE: Each DBP must bring at least one SSP. If you need a 2nd SSP we will try to match but cannot guarantee it.  Your name will go on a waiting list until we find a relief SSP for you.)

Please list SSP name(s) __________________________________________________________________________________________________
(Your SSP(s) should also list your name on their registration).

If you need a relief SSP, please list the name(s) of any SSPs you prefer: _______________________________________________________

Name of SSPs you prefer not to be matched with:
_______________________________________________________

I need an SSP(s):
__ for all or most activities   ___ for night time activities ___ for tours

Check the kind of SSPs you prefer:
____ Men   ____ Women   ____ Doesn’t Matter
____ Deaf  ____ Hearing   ____ Doesn’t Matter

COMMUNICATION PREFERENCES:  Please check all that apply.

Speech/Lip reading
____close up lip reading
____unaided
____aided   ____infrared   ____FM
____other assistive listening devices
type/brand:_____________________________________
____I will bring my own assistive listening device.

Sign Language
____platform   ____ ASL   ____PSE
____close vision   ____ASL   ____PSE   ____ fingerspelling
____ small groups   ____ one on one
____ tactile   ____ASL   ____PSE   ____fingerspelling
____ right hand only   ____ left hand only   ____both hands

TO BE FILLED OUT BY THE SSP ONLY:

SSP SKILLS INFORMATION

If you were asked to be an SSP by a Delegate, please put the name of the Delegate here: ________________________________________________
(Your Delegate should also list your name on their registration.)

­­______ Please check here if you have not been asked to be an SSP by a Delegate. (You will be assigned a delegate by the SSP Coordinators)

Please check what setting you are comfortable with:
Sign Language
____platform   ____ ASL   ____PSE
____close vision   ____ASL   ____PSE   ____ fingerspelling
____ small groups   ____ one on one
____ tactile   ____ASL   ____PSE   ____fingerspelling
____ right hand only  ____ left hand only   ____both hands
____ Oral Interpreting (Speech to Speech, close up lip reading)
____ Voice Interpreting  

                   ____ ASL to Voice   ____ PSE to Voice

I am comfortable helping with:
____ Swimming  ____ Socials ____ Tours
____ Push Wheelchair   ____ Meals
____ Help at Airport on first day  ____ on last day

TO BE FILLED OUT BY EVERYONE:

Would you like the travel agent to assist you with transportation to and from Orlando, Florida?   ___Yes  ___No

If yes, list the airport you prefer to fly from:_________________

Do you have any special request?     ___Yes  ___No

If yes, please list your request below and be specific: ____________________________________________________________________________________________________________________________________________________________

If you have any questions, please feel free to contact Lynn Jansen:

         Email Address: DeafBlindTravel@aol.com

         Telephone Number: 513-242-4171 (Voice)

Send deposit made payable to “D-BE” with completed registration forms (pages 4 –11) to:

         Deaf-Blind Explorers

         PO BOX 32015

         Cincinnati, OH  45232-0015

Registrations postmarked after February 15, 2010 will be considered late and will be accepted dependant on availability and will incur a $15.00 late fee. Registrations postmarked after March 22nd will not be accepted.

After we receive your completed registration forms and payment, we will send you a confirmation letter, an invoice, and a short form. The short form, which we will ask you to fill out, can be sent back to us later.  The short form will ask you for your travel arrangements to and from Orlando, Florida.

PAYMENT FORM

Package Price Per Person                                                             $______

Your 35% Deposit Amount Enclosed                                        - $______

Tax-deductible donation to help D-BE with

some expenses THANK YOU!!                                                       $______

Your balance:                                                                                $______

Please check here if you would like for us to add insurance:

         Yes_______     No_________ 

Pick one of four payment plans that you prefer:

______ of payments in the amount of $________ per payment*.

______ of monthly payments in the amount of $________ per month*.

______ full payment in the amount of $________*.

______ in another plan that I want.  (Please explain or be specific).

__________________________________________________________

__________________________________________________________

__________________________________________________________

*An invoice will be sent to you each and every time you make a payment. Final payment is due by April 18, 2010.

PAYMENT OPTIONS

 
__Check           __ Money Order

(Make payable to D-BE)

If using a credit card, fill out the following information.  Be sure the credit card information is exactly as on the card.

____ Credit Card (Visa or MasterCard only)*

Card Type:  __Visa    __MasterCard

Credit card number: ________________________________________

Expiration date: Month/Year _______/_______

Signature: ________________________________________________

If you are using another person’s credit card, please fill out the following

Name: _________________________________________________

Address: ________________________________________________

City/State/Zip ____________________________________________

Home Phone Number: ______________________________________

*If you pay by credit card, you may fax in your registration to the attention of D-BE at 513-242-4287.

Please check your choices (and amount due) and make sure all choices are marked in the proper column on each page. Double-check the total due so that we can process your registration without delay.

After we receive your completed registration forms and payment, we will send you a confirmation letter, an invoice, and a short form. The short form, which we will ask you to fill out, can be sent back to us later.  The short form will ask you for your travel arrangements to and from Orlando, Florida.