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 mike@suesmithvacations.com