Lange

 Group Cruise Registration Form
Once Filled Out We Will Call You or You May Call Us With Your Credit Card Deposit!

Group Name

Last   Name

Sailing Departure Date:

First Name Important: Legal Spelling

Address

City

State

Zip

Country

E-mail


Important! Please double check.

Citizenship

Day   Phone

Best Time to Call




Night
Phone

Have you            cruised before?  


FAX

Birth Date

mm/dd/yy

How did you hear about our site? 
 
  Type of cabin?  Cabin Category   # of cabins: 

Passenger # 2
Legal Name: Birth date:  Citizenship:
Passenger # 3
Legal Name: Birth date:  Citizenship:
Passenger # 4
Legal Name: Birth date:  Citizenship:

Do you need airfare? 
If yes, closest major airport ?  
  
Do You Need Bus Transfers?     Do you want insurance?   

Do You Want Pre-Paid Tips
Please indicate if special occasion you are celebrating near cruise date

If So, Anniversary or Birth Date: mm/dd/yy  Name:

Other Requests or Comments. Also, Please List Any Special Medical Conditions or Special Diets Required. If you are pregnant, how many months will it be at the time of the cruise.

   

If more than 4 passengers in 1 cabin, or if you are requesting more than 1 cabin, please enter the additional passenger information in the box above.

Please click the 'Submit' button only once, and wait for the confirmation page to appear This can take quite a while at busy times, please be patient.