Blacks Over 40 at Sea 2010
Reservation Form
Blacks Over 40, P. O. Box 18865, Philadelphia, PA 19119
Phone – 888-671-8948 ~ Fax – 775-213-3121 ~ Email – Cruise@BlacksOver40.org
Important Notice – You must have a valid Passport or you will not be allowed to board the ship.
Your first and last name must be as it appears on your Passport.
Last Name________________________________First Name__________________________
Mailing Address______________________________City____________________State____Zip Code_______
Day Phone (____)______________Evening Phone (____)______________Cell Phone (____)______________
Email_____________________________________________ US Citizen ___Y ___N
Date of Birth________/_______/________ Gender_____ T-Shirt Size___________
Cabinmate:
(Cabinmates must book within 30 days.)
Last Name________________________________First Name__________________________
Mailing Address______________________________City____________________State____Zip Code_______
Day Phone (____)_________________Evening Phone (____)_________________Cell Phone (____)_________________
Email________________________________________________ US Citizen ___Y ___N
Date of Birth________/_______/________ Gender_____ T-Shirt Size___________
Cabin Category: __ Inside__ Oceanview __ Balcony __ Demi-Suite
Occupancy: __ Single __Double
Pre-Cruise Package: ___1 Day ___2 Day ____No
Vacation Protection Insurance: ___Yes ___No
Special Accommodations: __ Dietary __ Wheelchair __Other
Special Occasion: Birthday___Anniversary____Other_____(Specify)
Form of Payment: Check/Money Order___Credit/Debit Card____
Name of Card Holder______________________________________
Billing address___________________________________________
Card Number_______________________Exp.________Credit Card Security Code_____
I have read and agree to the Terms and Conditions.
Signature_______________________________________
Group Leader/Group Code_________________________
