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Registration Request for
GREG EVIGAN
Sailing December 4-11, 2005 
on Holland America's Westerdam
Roundtrip from Ft. Lauderdale, Florida 
visiting Nassau, St. Marteen, Tortola, & Half Moon Cay
REGISTRATION FORM - deposit $350.00 per guest
 

Personal Information
**IMPORTANT** The First and Last Name that you type below, Must Match your VALID PASSPORT which is required to board the ship
1st Passenger
First Name
Last Name
Date of Birth
Identification
2nd Passenger
First Name
Last Name
Date of Birth
Identification
Address
City
State
ZIP Code
Country
Phone (Day)
Phone (Evening)
Email Address

Cruise Preferences
Room Preference
Inside Cabin Ocean View
Twin Beds Queen Bed
Dining Table
Small Large
Most of the group will be having dinner at the second seating which is around 8PM.  If you prefer to dine at 6PM, Check Here
 
Special Requests, dietary or medical requirements:

Names of friends you wish to dine with:
   
   
 
If you require air arrangements and transfers between the airport and ship please enter you departure city:

Cabin Category & Pricing
Twin Share Rates*
(Prices are Per Person)
Single Rates*
Please see Rates & Pricing for Details
*Port Tax is an additional $184.23 per person

Travel Insurance
Travel Guard Insurance - Up to Age 59. Covers 100% for covered reasons
(Plus $6 Policy Fee)
Holland America Insurance can only be purchased with your deposit. Allows you to cancel up to 24 hours prior to receive a percentage of your money back.

Please see Terms & Conditions for more information
 

Payment Information
A $350 deposit is required for each passenger, you may provide your credit card number now or by phone later by selecting 'Pay by Phone' below (an operator will contact you for your details).  Final Payment is due by: 8/1/05
Payment Method
Credit Card or Phone Number
Cardholder
Expiration Date
Tick here to use the same card for your final payment
Are you interested in charging monthly installment Payments?  If so how much per month? $

Optional Information
How did you hear about this cruise?

Agree: 
Please select Yes to verify that you have read and agree to the   Terms & Conditions as all questions have been answered.

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Fax: 215-355-6664
Email: Susan@CruiseEvents.net