ARKANSAS RETIRED TEACHERS ASSOCIATION Canada New England NCL DAWN October 3-10, 2014 CONFIRMATION: GROUP NAME: ARTA – Canada/NE 2014 Dates of Travel: October 3-10, 2014 Please Print: LEGAL NAME:___________________________ BIRTHDAY: ___________ (as it appears on Passport) LEGAL NAME: ___________________________BIRTHDAY: ___________ Date of Booking: ___________________ NOTE: A Passport is required for this trip. Please provide a copy for our records. (as it appears on Passport) ADDRESS: ______________________________________________________ CITY: ________________________ STATE:__________ ZIP: _____________ HOME PHONE: ______________________ WORK PHONE: _____________ E-MAIL: _________________________________________________________ BOOKING INFORMATION: Option Price (per person double) Balcony (BD) $2,385.00 Ocean View (OB) $1,935.00 Inside (IB) $1,725.00 Total NOTE: Number of people _______ _______ _______ Total Price $__________ $__________ $__________ $__________ Deposit (per person) Total Deposit $ 600.00 $_________ $ 600.00 $_________ $ 600.00 $_________ $_________ Final Payment is due by July 15, 2014, 2013 Credit Card Information: Number: __________________________________ Exp Date: __________ Security Code: ___________________ Passport Information:: Number: ________________________ Expiration Date: __________________________ Issuing Agency: _______________________ Travel Insurance Coverage _____ Accept _____ Decline (please initial) EMERGENCY CONTACT INFORMATION: NAME: __________________________________________________ RELATIONSHIP: _____________________________________ ADDRESS: _______________________________________ CITY: ________________________ STATE: _______ ZIP: ___________ HOME PHONE: ________________________________________ WORK PHONE: ________________________________________ SEND REGISTRATION AND PAYMENTS TO: Sue Smith Vacations 3806 JFK North Little Rock, AR 72116 FOR INFORMATION CONTACT: Mike Wilkinson 501-771-0987 mike@suesmithvacations.com