Circle K Great Lakes Division - Ambassador Club Trip

REGISTRATION

WINNER/PRIMARY'S INFORMATION

Note: if you are applying for a passport, please include the name as it appears on your passport application.

PLEASE NOTE: The current processing time for new passports is 6 to 8 weeks. Please choose the expedite option when requesting passports. The expedite option is currently taking 2 to 3 weeks to process.

First Name (as it appears on your passport)

Middle Name (as it appears on your passport)

Last Name (as it appears on your passport)

Preferred First and Last Name on Name Badge

Birth Month:

Birth Day:

Birth Year (YYYY):

Gender:

Do you have a passport?

Company Name:

Mobile Phone:

Email Address:

Emergency Contact's Name:

Emergency Contact's Phone

Do you have dietary restrictions?

Address 1:

Address 2:

City:

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Postal Code:

Country:

Are you bringing a guest? (All guests must be at least 18 years old.)

AIR TRAVEL PREFERENCES

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EXCURSION SELECTION

For Tuesday, November 5, Circle K Great Lakes is covering one excursion per person. You can purchase additional excursions when you arrive Jamaica at the Circle K Great Lakes Ambassador Club Trip Hospitality Desk.

Please select an excursion to view its description.

Excursion Options:

GENERAL RELEASE & AGREEMENT

I understand that I am not required to attend by Mac's Convenience Stores, LLC, but instead have chosen to participate of my own free will.

I understand that Mac's Convenience Stores, LLC and its affiliated companies (hereafter collectively called "Company" or the "Companies") have no control over the people, equipment or operations of any transportation company, airline, ship line, hotel, restaurant, or any other person or entity furnishing services, products or accommodations as part of this travel program. All suppliers are independent contractors and are not employees or agents of the Companies.

Because of the foregoing, I, on behalf of myself, my heirs, executors, administrators, successors and/or assigns, agree to release, defend, indemnify, and hold the Companies and their respective officers, directors and employees harmless from any and all liabilities, damages, losses, delays, inconveniences, costs and expenses, including, without limitation, reasonable attorney's fees and court costs, which are caused, directly or indirectly, by any of these independent contractors or their agents, servants or employees.

Additionally, I, on behalf of myself, my heirs, executors, administrators, successors and/or assigns, agree to release, defend, indemnify, and hold the Companies' licensed bottlers, distributors, and their respective parents, affiliates and subsidiary companies, promotional or advertising agencies, any supplier involved in the event and their respective employees, agents, representatives, successors, assigns and officers ("Company Sponsors") harmless from and against any and all suits, actions, demands, claims, costs, expenses and damages of any kind whatsoever, including reasonable attorney's fees, arising directly or indirectly as a result of the falsity of any of the statements made by me herein.

I further understand that during this Event, I may have the opportunity to participate in various tours, water sports, athletic activities, contests, excursions and side trips. A decision by me to participate in any such activity must be mine alone and as agreed above, I hold the Companies harmless from any claims that might arise from the event.

I do hereby also release and will hold Company and Company Sponsors from any liability of any kind whatsoever which I, or my heirs, executors, administrators and assigns had, now have or hereafter may have, or that any third party had, may have or hereafter may have, by reason of any matter connected to the Event, the awarding of the trip, any loss or damage to any prize and any action, claim or suit for personal injury or loss or damage to property in connection with my traveling to and participating in the Event and/or offered activities.

I agree to be solely responsible for all unspecified costs/expenses involved in the trip, including but not limited to, those that might be personally incurred by me.

CIRCLE K INCENTIVE TRIP POLICY

I am participating in a class, or other organized event on Circle K Stores, Inc. property. I understand that this is not a work-related event, nor am I required to attend by Circle K Stores, Inc.

In consideration for the use of the Secrets Jamaica property for this event, I hereby release Circle K Stores, Inc., its Officers, Directors, Managers, Employees or other Agents, collectively Circle K Stores, Inc. from any liability, real or perceived, which may arise as a result of my participation in this event. I understand that I am voluntarily assuming the risk of any potential accident or injury, and accordingly, agree not to assert against Circle K Stores, Inc. any cause of action which may arise from such injury or accident.

Circle K believes that it is important to recognize and reward the top performing individuals that go above and beyond in achieving fundraising goals. Circle K has developed an incentive trip as a way to recognize and thank these Circle K employees.

Procedures

1. Each year a special destination is selected for the incentive trip, typically including:

5-7-night stay at an exclusive resort or on a cruise ship
Airline round-trip travel
Recognition events
Transportation to and from the hotel and airport

5-7-night stay at an exclusive resort or on a cruise ship

Airline round-trip travel

Recognition events

Transportation to and from the hotel and airport

2. All incentive award participants can also bring one individual with them on the trip who is at least 18 years of age (family member, friend, etc.)

3. The total expenses related to the annual incentive trip are estimated to be $3000 per person for each individual who attends the incentive trip. The estimate may change due to actual trip costs and the number of participants. Circle K determines this amount by taking the total of the direct cost related to the incentive trip and dividing that number by the participating attendees. Circle K will communicate to all participants in advance of any incentive trip to anticipate expenses for each event including any significant cost increases for any future incentive trips planned.

4. The cost of the trip for employee and guest is considered taxable income to the employee. The taxable income will be grossed up to cover the employee's federal and state taxes and will be reported on the W-2.

Requirements | Pertaining Only To Circle K Employees

1. If a Circle K employee is awarded a trip, the employee must use his/her accrued vacation when requesting time off for the occasion.

2. If a Circle K employee who is selected to participate in the incentive trip is not able to attend, for personal reasons or other business priorities, he/she may decline participation. There will be no monetary value paid in lieu of the incentive trip option to anyone who declines participation. It is necessary that the employee who declines the invitation provide as much notification in advance to Circle K Senior Management. As a courtesy, such notification is essential in order to keep incentive trip expenses down. There will be no replacement if this does occur.

3. Circle K's Great Lakes Vice President based on his sole discretion will determine who will be invited to participate in the incentive trip.

4. If a Circle K employee wants to take another Circle K employee, VP of the Great Lakes needs to approve. The guest Circle K employee needs to be a relative, spouse, or significant other/partner. No exceptions.

Exceptions: NONE

I agree to the terms and conditions outlined above.

VERIFICATION

Please verify your responses before submitting them:

Once you click submit, you will be re-directed to register your guest information, if applicable.

WINNER INFORMATION

AIR TRAVEL PREFERENCES

EXCURSION SELECTION

HOTEL ACCOMMODATIONS

POLICY