CABIN REQUEST DEPOSIT NOTICE • Please fax this form to (503)256-8516 or mail to: RHANW, 11320 SE Lincoln St, Portland, OR 97216 or fax to 360 576 1057 (Prices are subject to change so book early.) If booking a veranda or suite cabin do not wait. Book early to avoid price increase. • Please fill out one form for each cabin. • If more than one credit card, per cabin, is being used fill out separate forms and note persons who are sharing the cabin. • Final Payment due: 7/23/10; Penalties begin 8/23/10 Names and dates of birth (must be first and last legal names only) **Names must match passport (EXCEPT no middle names) or required documentation as stated on www.travel.state.gov ** LAST NAME, FIRST NAME GENDER Date of Birth PAST GUEST NUMBER U.S. Citizen? EMAIL ADDRESS 1. ______________________________________________________________________Y / N_________________________ 2. ______________________________________________________________________Y / N_________________________ 3. ______________________________________________________________________Y / N_________________________ 4. ______________________________________________________________________Y / N_________________________ Cabin Category: _______________________________________________________________ Insurance: Is an option you can purchase with final payment except for those who reside in CA, FL, NY, NC, OR, TX or WA. Other insurance options may be available. Special Request: (cabin near another group member, handicap room, special occasion, special needs, pregnancy, etc): ______________________________________________________________ Credit Card Information: Visa MasterCard American Express *Special note on debit cards: debit cards have maximum daily limits; please verify with your bank that the dollar amount being charged can be processed in one transaction. Cardholder Name: ___________________________________________________ Billing Address: ____________________________________________________ ____________________________________________________ Telephone Number: _____________________________Home or Cell (circle one) Cruise Deposit amount: $150 per passenger Amount authorizing to charge: _____________ Card #: _______________________________________________ Exp: ___ / ____ |
Red Hat Adventures NW Carnival The Fun Ships 4 Night Southern California Cruise - Carnival Cruise Lines - Carnival Paradise Departing from: Los Angeles (Long Beach, CA) - Departing date: October 25, 2010 Group Leaders: Lise Thom (503) 252-7670 – lisethom@aol.com Jean Mounsey (360) 904-0332 - j.mounsey@comcast.net www.redhatadventuresnw.com |