CRUISE REGISTRATION

(Please Print)

 

NAME:            _________________________________________________________

 ADDRESS:    __________________________________________________________

 CITY:              ______________________ STATE:______ ZIP CODE:____________

        

DAYTIME PHONE: ____________________________________________________

E-MAIL:        __________________________________________________________

BIRTHDATE:  _________________________________________________________

(All NAMES MUST BE AS THEY ARE ON YOUR PASSPORTS)

 LIST NAMES OF OTHER PEOPLE IN YOUR CABIN

 1. __________________________________BIRTHDATE:________________

 2. __________________________________BIRTHDATE:________________

 3. __________________________________BIRTHDATE:________________

 4. __________________________________BIRTHDATE:________________

CHECK BELOW

 ______ INSIDE CABIN                              $599.00 Per person for the first two people

                                                                        (Single supplement $250)

 ______OUTSIDE CABIN                           $659.00 Per person for the first two people

                                                                        (Single supplement $250)

______THIRD & FOURTH PERSONS   $499.00 Each

  

DEPOSIT ($100 per person)    

 CREDIT CARD #_____________________________  EXP.____________

                               Visa or MasterCard preferred

SIGNATURE: _________________________________________________

 MAKE CHECKS PAYABLE TO:  KIRK TALLEY                                              

                                                            P. O. BOX 6568

                                                            KNOXVILLE, TN 37914