MOAA CRUISE REGISTRATION FORM, MS ZAANDAM
Western Caribbean, Departs Port Canaveral Sat, 3 Apr 2004, Returns Sat, 10 Apr 2004
Please print except for signatures. Names must be exactly as they appear on your
passport.
* Proof of
citizenship is mandatory
M/D/Y
1.Nme/Rnk/Svc________________________ *
Nationality_______ DoB_________ Gender ___
M/D/Y
2.Nme/Rnk/Svc ________________________ *Nationality
______ DoB ________ Gender ___
(Attach additional page for third and fourth passenger)
Address _______________________ City _________________
State ____ Zip _______
Home Tel Number _______________ E-Mail Address
__________________________
Emergency Contact and Phone Number
____________________________________________
Chapter Name ______________________ Cabin Category
Preference __________________
Dinner is 1st Seating, Dining Companion(s)
_________________________ ________________
Name to be Placed on Nametag 1st Nme
______________________ 2d ____________________
$350 DEPOSIT ENCLOSED OR TO BE CHARGED TO CREDIT
CARD. Make checks payable to Good
Friends Travel Service. Final payment
is due not later then 4 Jan 2004.
M/Y
Credit Card Company _______ Credit Card Number
_______________________Exp _______
Name on Credit Card (Exactly as Shown)
___________________________________
I authorize Good Friends Travel Services, Inc, to use
this credit card for the required payments for this cruise.
____________________________
Signature
of Cardholder
Please provide me with information concerning
cancellation and emergency medical insurance.
Yes ___ No ___ Special Request ___________________________________
Mail or FAX this form to: Good Friends Travel Service Tel: 321-777-0130
2326 N A1A Toll
Free: 800-407-0099
Indialantic FL
32903 AX: 321-777-0132
Final Payment ________ _________ ___________ ________