WAIVER, RELEASE OF LIABILITY, INDEMNIFICATION AND ASSUMPTION OF RISK FORM

FOR TRAVEL TO A COUNTRY WITH A LEVEL 3 OR 4 DEPARTMENT OF STATE TRAVEL ADVISORY OR CDC LEVEL 3 OR 4 HEALTH NOTICE

Carefully read the U.S. Department of State Travel Advisory for the destination country/ies at http://travel.state.gov/content/travel/en/traveladvisories/traveladvisories.html, the Centers for Disease Control and Prevention Health Notices at http://wwwnc.cdc.gov/travel/destinations/list and this Waiver, Release, and Assumption of Risk.