245 E Old Sturbridge Rd • Brimfield, MA 01010

Operated by Search Beyond Adventures, Inc.

Travel for adults with disabilities(800) 800-9979

My Vacation, IncMay 2020 - March 2021

Vacation Tours

Double room occupancy

1:1 staff to participant ratios

Personal care attendant costs

All meals

Price includes:

My Vacation, Inc.About My Vacation, Inc...

My Vacation, Inc (formerly Pumpernickel Places)are specialized tours planned for vacationersneeding or desiring a high level of assistance orsupervision. Many of these tours are wheelchairaccessible and are staffed on a 1:1 ratio. Toursare small--typically only three or four travelers pluschaperones--so daily schedules are flexible andparticipants receive abundant attention.

Prices include:• double-occupancy accommodations• all meals, even desserts!• all activities (on-shore cruise activities optional)• wheelchair accessible transportation, many tours• You can bring your own attendant or choose for

us to provide one• pre-tour and post-tour calls from the tour leader

or tour coordinator

Since our customers come from all over the coun-try, prices do NOT include airfare for the cus-tomer or attendant to the destination. We willticket air travel for you and bill you approximately30 days prior to the tour.

We also offer customized FLORIDA vacations justfor you or you and a friend! This programenables not only individuals, but couples and fam-ily members to now enjoy a customized assistedvacation in Orlando. Choose just the activities youwant at the pace that works for you. Choose thenumber of days, even the airline. This is not agroup vacation; it's your vacation!

My Vacation, Inc is a sister company of SearchBeyond Adventures, Inc. Banking and accountingare separate so please use the attached applica-tion. Make checks payable to “My Vacation”.

May 2020 - March 2021 My Vacation tours

Washington DC 5 days

! Tour some of the Smithonian buildings andother national musems

! Learn from an escorted tour of the Capitol! Watch money being made at the Bureau of

Engraving! Visit some of the Mall memorials (eg

Jefferson, Roosevelt, Lincoln, VietnamWar)

Ratios & Prices: June 5-9, 20201:1, your attendant- $23101:1, our attendant- $2590

Disney World Florida 5 days

! Meet Micky and friends at Disney’s MagicKingdom

! Explore the rides, shows, and exhibits atone of the other three Disney parks

! Enjoy the entertainment and food at a din-ner show

Ratios & Prices: May 16-20, 2020Oct. 3-7, 2020

1:1, your attendant- $20551:1, our attendant- $2335

(800) 800-9979

May 2020 - March 2021 My Vacation tours

San Antonio

! Ride the flatboats through the canals! Tour the Alamo and learn about legendary

Davy Crockett! Wander the Paseo del Rio (“Riverwalk”)! Watch “The Price of Freedom” on IMAX

Ratios & Prices: Mar. 20-24, 20211:1, your attendant- $20301:1, our attendant- $2300

Hawaii 6 days! Watch Pacific culture performances at the

Polynesian Cultural Center! Explore everything pineapple at the Dole

Plantation! Tour the historic USS Arizona museum and

war memorial at Pearl Harbor! Enjoy sun and sand at a Hawaiian beachRatios & Prices: Nov 19-24, 20201:1, your attendant- $28651:1, our attendant- $3195

Las Vegas 5 days

! Be entertained at two different Las Vegasshows

! Check out M&M World and other sights onthe “strip”

! Win or lose money at some of the casinos

Ratios & Prices: July 18-22, 2020Nov. 7-11, 2020

1:1, your attendant- $21501:1, our attendant- $2430

Nashville 5 days

! Enjoy a performance at the famous GrandOle Opy

! Tour the Country Music Hall of Fame! Attend a musical show at the Nashville

Nightlife Theater, or similar! Tour RCA Studio B where Elvis recorded

many of his albums

Ratios & Prices: Sept. 17-21, 20201:1, your attendant- $20551:1, our attendant- $2325

Vermont 5 days

! Ride a gondola to the top of Vermont’shighest mountain: Mt. Mansfield

! Sample ice cream flavors at Ben & Jerry’s! Tour the Vermont Teddy Bear factory! Relax on a cruise on Lake Champlain! Watch chocolatiers at work at Lake

Champlain Chocolates

Ratios & Prices: Aug. 21-25, 20201:1, your attendant- $23301:1, our attendant- $2610

Disneyland California 5 days

! Enjoy Disneyland’s parades and rides! Explore Disney’s second theme park,

California Adventure! Visit and shop at Hollywood’s boulevard of

the stars! Ride through famous Beverly Hills

Ratios & Prices: Dec. 10-14, 20201:1, your attendant- $22351:1, our attendant- $2505

Memphis 5 days

! Tour Elvis’ mansion, Graceland! Visit Sun Studios where Elvis recorded his

first album! Tour the Rock and Soul Museum! Listen to the blues on world famous Beale St! Learn about Martin Luther King at the

National Civil Rights Museum.

Ratios & Prices: Oct. 16-20, 20201:1, your attendant- $20251:1, our attendant- $2295

Disney/Universal Florida 6 days

! Meet Micky and friends at Disney’s MagicKingdom

! Explore the rides, shows, and exhibits atone of the other three Disney parks

! Enjoy the entertainment and food at a din-ner show

! Thrill at the shows and rides at UniversalStudios

Ratios & Prices: Feb. 14-19, 20211:1, your attendant- $25351:1, our attendant- $2865

My Vacation, IncRegistration Form

APPLICANT'S NAME:

TOUR NAME:

TOUR DATES:

STAFFING CHOICE: ❑ 1:1 ratio (bringing own attendant) ❑ 1:1 ratio (using ‘My Vacation’ attendant)

GENERAL INFORMATION: (Please Print!)Age: ____________ Birthdate: __________________ Gender: Male_______ Female____ Preferred Airport: ___________________If home address is different from agency address to which address should trip information be sent? ❑ Home ❑ Agency ❑ Address is SameHome Street: _______________________________ City: __________________ State: _____ ZIP: _________ Phone: (____)_________If you would like tour information faxed or e-mailed to you: Fax Number: (____)_______________ E-Mail: _______________________ Type of Living Situation (check one): ❑ Family ❑ Community Residence ❑ Superv. Apt. ❑ Indep. Living ❑ Other____________Agency Name: ________________________________________________ Phone: (____)________________ Contact: _______________Agency Address (if different from home address): Street: ___________________________ City: _____________ State: ____ ZIP: _______Agency Fax: (____)____________ Emergency phone # (for nights or weekends): (____)__________________________________Whom do we contact in case of emergency? (include night or weekend contact name) ______________________________________________Person completing this application: ___________________________ Relationship or Title: _______________ Phone: (___)___________

PHYSICAL INFORMATION:

Blind?_________ Eyeglasses?________ Deaf?_________ Hearing Aid?_________ Dentures?_________ Prosthetic Device?__________Memory Deficit Disorder?_________ Autism?_________ Diabetic?_________ Language/Communication difficulties ___________________Fully ambulatory?___________ If no, what aids do you use? Man. Wheelchair_____ Elec. Wheelchair_____ Walker_____ Cane__Seizures?_________ If seizures, please describe frequency and type: ________________________________________________________Control of bowel and bladder?_______ If occasional incontinence, please describe below the frequency, times, and treatment:________________________________________________________________________________________________________

WHEELCHAIR USERS ONLY: Is wheelchair manual? ❑ or electric? ❑ If manual chair can you self-propel your chair? ❑ or do you need to be pushed? ❑Indicate type of assistance needed for transfers: ❑ one-person pivot ❑ two-person ❑ other (explain): ____________________________Can you support weight while transferring? ❑ yes ❑ no Comments: __________________________________________________Please list any other assistant devises you will need to bring on this tour: ____________________________________________________

SPECIAL NEEDS INFORMATION:Please describe any physical problems or physical disabilities, activity limitations, special equipment needed.

SELF CARE SKILLS:Independent Needs Assistance* Independent Needs Assistance*

Dressing _____ _____ Street Safety _____ _____Bathing _____ _____ Eating _____ _____Toileting _____ _____ Hygiene _____ _____

*Please describe how much assistance is needed in any of the skill areas listed above:

Terms: Enclose a minimum of 20 percent deposit with application. Balance due 45 days prior to departure.Make checks payable to: “My Vacation”

My Vacation, Inc • (800) 800-9979 • Fax: (877) 721-3409245 E Old Sturbridge Rd • Brimfield, MA 01010