CME & CULTURAL TOUR OF BALI

APRIL 27 - MAY 13, 2025

REGISTRATION / BOOKING FORM

GROUP MEDICAL DIRECTOR:

DR. PETER BLOCH, OAKVILLE, ON.

LAST FEW ROOMS !

REGISTER BY DECEMBER 20, 2024 & SAVE $1,000 COUPLE !

How many passengers are to be included on this registration form? * 🛈

Personal Information

(DETAILS MUST MATCH PASSPORT EXACTLY)

1.

Title *

First *

Middle 🛈

Surname *

Date of Birth * +

Special Meal
Required? *

Gender *

If you are interested in making a medical presentation, please let us know your subject:

Badge name 🛈

Special Meal Requirements: *

2.

Title *

First *

Middle 🛈

Surname *

Date of Birth * +

Special Meal
Required? *

Gender *

If you are interested in making a medical presentation, please let us know your subject:

Badge name 🛈

Special Meal Requirements: *

3.

Title *

First *

Middle 🛈

Surname *

Date of Birth * +

Special Meal
Required? *

Gender *

If you are interested in making a medical presentation, please let us know your subject:

Badge name 🛈

Special Meal Requirements: *

Passport Information

* Note: A valid passport (expiring no earlier than 6 months after your scheduled departure from the region) is required for entry into the destination.

1.

Passport No. *

Date of Issue * +

Date of Expiry * +

Place of Issue *

Nationality *

Profession *

2.

Passport No. *

Date of Issue * +

Date of Expiry * +

Place of Issue *

Nationality *

Profession *

3.

Passport No. *

Date of Issue * +

Date of Expiry * +

Place of Issue *

Nationality *

Profession *

Contact Information

Street Address *

Address Line 2

City *

Province/State/Region *

Zip/Postal Code *

Country *

Phone # (home/cell) *

Phone # (business)

Phone # (fax)

Email Address *

Email Address (secondary)

Tour Pricing

Please place a check in each applicable box (tour item) for each passenger. All prices are per passenger in CANADIAN$.

PASSENGER

a) CME & Cultural Tour of Bali (see Note 1) - $8,295

b) Single supplement (if travelling alone in your own room) - $1,720

c) Single share fee (if you're single and we find you a roommate) - $300

d) Supplemental taxes and fees - $745

e) N/A

f) N/A

g) Academic CME Program Registration fee - $950

1

2

3

Repeat Customer Discount :

Enter $100 for each of the passenger's previous tours with us, up to a maximum of

$300 (3 tours). Final balance payment must be made by Cheque to qualify.

___________________________________________________________________

Total insurable costs per passenger :

Pass. 1 🛈

0.00

Pass. 2 🛈

0.00

Pass. 3 🛈

0.00

___________________________________________________________________

Order Total :

Current Total: 🛈

$0.00

* Originating flights are available from either Toronto, Montreal, Vancouver, or Calgary.
Please choose your origin city below: *

** Notes

1. Includes round trip flights from Toronto (other originating cities listed - supplement applies). Early booking price of Cdn$8,295/person is valid until December 20, 2025, for bookings after this date the price increases to Cdn$8,795/person.

Travel Insurance

We strongly recommend that you take out travel insurance to protect you against the unexpected due to, in particular, limited provincial health care coverage afforded to Canadians while traveling overseas and the cancellation provisions inherent in your booking. We offer the following insurance coverage options through Manulife Insurance, one of Canada’s leading insurance providers –

NON-MEDICAL INCLUSIVE PLAN

There are significant inherent cancellation penalties associated with your booking as detailed in our booking terms and conditions and this insurance package provides coverage for all monies paid for your trip if you should have to cancel due to medical, or other listed, reasons either relating to yourself or a member of your immediate family. It also covers you for trip interruption costs short notice return flight home etc) for medical reasons again, either relating to yourself or an immediate family member as well as flight and travel accident and baggage insurance.

ALL INCLUSIVE PLAN

This plan provides coverage for all the components in the Non-medical Inclusive plan, plus unlimited health coverage while in the destination.

"Cancel for any reason (CFAR)" coverage - NEW and at no additional cost !!

So long as you purchase either of the two insurance policies above at the same time as your tour booking, you are automatically entitled to this added benefit of CFAR coverage whereby, if you need to cancel your tour booking up to 14 days or more before departure for any reason, your policy will refund you up to a maximum of 50% of the cancellation penalties incurred. This is excellent peace of mind coverage to protect you against (50% of the) cancellation penalties incurred in a situation where the reason for cancellation is not one of the regular covered risks in your policy (ie it is essentially "change of mind" insurance).

PREMIUM PROTECTION PLAN (“PPP”)

As a third option, Manulife is now also offering a new enhanced travel insurance policy, their Premium Protection Plan (“PPP”). This is Manulife’s most comprehensive coverage, providing all the same types of coverage as the All-Inclusive plan (above) but with higher covered amounts in most areas. It is also a simplified policy in so much that, whereas the All-Inclusive plan and Non-medical Inclusive plan (above, and as is the case with most insurance company travel policies) have a list of specific covered events, the PPP offers cancellation coverage for any unexpected and unforeseen event (ie., any event, situation or circumstance that is beyond your control that prevents you from travelling) with only a few exclusions that apply.

An overview of the PPP may be found by clicking here

A comparison of the enhanced benefits provided by the PPP compared to Manulife’s regular All Inclusive plan may be found by clicking here

And, in these uncertain times, a major benefit of the PPP is that coverage for reimbursement of inherent cancellation penalties under the Cancel For Any Reason (CFAR)" coverage is increased to 80% of the cancellation penalties incurred for all cancellation up to 7 days or more before departure.

Please note, the PPP is only available to clients under the age of 75 (at the date of purchase of the insurance coverage) and must be purchased at the same time as the travel tour booking is made (72 hour grace period).

A detailed overview of coverage benefits and limitations of each insurance policy that we offer through Manulife may be found at -

https://www.igoinsured.com/Direct/ManulifeGlobal.aspx?ag=ONTOTPR&lang=E

** Non-Canadian residents

For residents of countries outside of Canada (including the USA), insurance regulations allow us to sell “Trip Cancellation” insurance (this policy includes both trip cancellation and trip interruption coverage but not medical coverage). Hence it is not possible for non-Canadian residents to purchase either the All Inclusive or Premium Protection plans from Manulife. We do find that many of our overseas clients already have medical insurance through other channels and therefore, if this is the case, you may purchase “Trip Cancellation” coverage by following the link below to purchase the “Trip Cancellation” insurance policy (taking advantage of our preferred rates with Manulife) via our company’s exclusive Manulife link:

https://www.igoinsured.com/Direct/ManulifeGlobal.aspx?ag=ONTOTPR&lang=E

** For residents of Ontario, simply accept your choice of insurance (Non-medical Inclusive, All-Inclusive or Premium Protection coverage) below and we will apply the corresponding insurance premium(s) on your invoice confirmation.

Choice of travel insurance: *

Non-Medical Inclusive

All-Inclusive Plan

Premium Protection Plan

No insurance

Each individual passenger's insurance premium is based upon their total insurable costs (total for all passengers is shown above using the "Calculate" button) and their age at the date of booking. Using this information, you may find amount of the premium using the table shown below. The insurance premium is due at the time of booking with the tour deposit. More payment information can be found in the next section.

Note: Total Insurable Costs relate to the total cost of your booking (including all taxes fees and miscellaneous other amounts) on a per person basis (as seen using the individual total calculations in the Tour Pricing section).

** For residents of Canadian provinces other than Ontario, insurance regulations state that travel insurance should be taken out directly with Manulife Insurance, albeit through a direct web link hosted on our web site, ie you should purchase your travel insurance policy by simply following the link below to take advantage of our preferred rates with Manulife) via our company’s exclusive Man ulife link:

https://www.igoinsured.com/Direct/ManulifeGlobal.aspx?ag=ONTOTPR&lang=E

Choice of travel insurance: *

Non-Medical Inclusive (via Manulife web-link)

All-Inclusive Plan (via Manulife web-link)

Premium Protection Plan (via Manulife web-link)

No insurance

Travel insurance that may be available through your credit card

When considering any of the travel insurance policies above, if you believe you may have coverage through your credit card we would strongly advise checking with the credit card company the actual coverage afforded to ensure it covers medical, trip cancellation and trip interruption as not all of these items are always covered. Also, if they are covered, the actual coverage limits for trip cancellation and trip interruption can often be quite limited as to trip duration or insured $ amount in the event of a claim (for example, it is not uncommon for trip cancellation coverage to be limited to approximately $2,500 (and sometimes lower..) per booking (rather than per person) and for trip interruption to be limited to $1,000 per person – you would need to check with your credit card company for actual coverage levels).

Also, most coverage through credit card benefits does not include Cancel For Any Reason (CFAR) coverage.

If it is still your intention to decline our insurance, please place a checkmark in the box below. Otherwise, please select a travel insurance package from the selection above.

Insurance declined waiver *

I hereby decline the travel insurance offerings above on behalf of all passengers listed on this registration form

Payment

PAYMENT INFORMATION

DEPOSIT

- $1,000 per person + applicable insurance premium (see table in Tour Pricing section), both non-refundable

- Payable by credit card only with registration

BALANCE

- Final balance amount will be indicated on our invoice confirmation which will be provided to you following our receipt of this online registration form

- Due by no later than January 5, 2025 (for registrations received on or after this date, payment is required in full at the time of booking)

- Payable by credit card or cheque or e-transfer

PAYMENT METHOD

We accept payment by either cheque, e-transfer or credit card (Visa and Mastercard only; American Express not accepted)

PAYMENT BY CHEQUE OR E-TRANSFER

Upon receipt of our invoice confirmation, please send a cheque for your balance post-dated to January 5, 2025, payable to Doctors-on-Tour.

Balance payments must be made by cheque or e-transfer if you are taking advantage of our Repeat Customer Discount.

Doctors-on-Tour

20 Princeton Road

Toronto, On.

Canada

M8X 2E2

PAYMENT BY CREDIT CARD

Please complete the credit card information below. Even if you are paying the balance by cheque or e-transfer, deposits must be paid via credit card.

* All credit card data entered on our form is protected by SSL encryption and hosted on our secure server.

See the https:// secure website verification in the page URL (address).

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

CCV (3-digit # on back of card) *

Is your credit card billing address the same as your mailing address provided in the "Contact Information" section? *

CREDIT CARD BILLING ADDRESS

Street Address *

Address Line 2

City *

Province/State/Region *

Zip/Postal Code *

Country *

Please indicate the method of payment for your final balance. *

Cheque

E-transfer

Credit Card

Please indicate the method of payment for your final balance. *

Cheque

E-transfer

** Since you are taking advantage of our Repeat Customer Discount, balance payments must be made by cheque or e-transfer. If you wish to pay your final balance by credit card, you must remove the Repeat Customer Discounts in the Tour Pricing section, at which point the 'Credit card' option will be available for selection above.

Credit card authorization *

I authorize on-tour to bill the credit card above for the deposit and applicable insurance premium, as well as to automatically charge the credit card with the final balance due on January 5, 2025, as well as any additional chargeable items approved by myself in writing (including by electronic mail)

Credit card authorization *

I authorize on-tour to bill the credit card above for the deposit and applicable insurance premium, as well as any additional chargeable items approved by myself in writing (including by electronic mail)

Terms & Conditions - Please read our T&C at this page on our site *

I have read, and accept the Terms & Conditions provided to me above on behalf of myself and all other tour participants on this registration form

Liability Waiver - Please read our Release of Liability Waiver at this page on our site. *

I have read, and accept, the Release of Liability Waiver provided to me at the link above on behalf of myself and all other tour participants listed on this registration form

CME Program Newsletter updates - please send me future notifications by e-mail

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