Booking Form - Sue Smith Vacations

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ARKANSAS RETIRED TEACHERS ASSOCIATION
NCL Pride of America February 13 - 23, 2014
CONFIRMATION:
GROUP NAME: ARTA – Hawaii 2014
Dates of Travel: February 13-22, 2014
Please Print:
LEGAL NAME:___________________________ BIRTHDAY: ___________
(as it appears on Drivers License)
LEGAL NAME: ___________________________BIRTHDAY: ___________
Date of Booking: ___________________
NOTE: A Government issued Photo ID
(as it appears on Drivers License)
ADDRESS: ______________________________________________________
is required for this trip. Please
CITY: ________________________ STATE:__________ ZIP: _____________
provide a copy for our records.
HOME PHONE: ______________________ WORK PHONE: _____________
E-MAIL: _________________________________________________________
BOOKING INFORMATION:
Option
Price (per person double)
Balcony (BE)
$4,370.00
Inside (IB)
$3,725.00
Total
NOTE:
Number of people
_______
_______
Total Price
$__________
$__________
$__________
Deposit (per person) Total Deposit
$ 600.00
$_________
$ 600.00
$_________
$_________
Final Payment is due by November 1, 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
[email protected]
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