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The Island Princess Alaska Cruise 2008

Personal Data


Legal Name
(as it appears on your passport)
Mailing Address
City, State Zip
Home Telephone
Email

Are you a US citizen?
Yes No
Date of Birth
(MMDDYY)


Male Female

Passport #
Country of Issue
Spouse or roomate's name
(as it appears on their passport)
Roommate's Mailing Address
Roommate's City,State Zip
Roommate's Home Telephone
Roommate's Email

Is your Roommate a US citizen?
Yes No
Roommate's Date of Birth (MMDDYY)


Male Female

Roommate's Passport #
Country of Issue

 

Emergency Contact Person (Not travelling with you)



Your Contact Name
Relationship to you
Address
City, State, Zip
Home Telephone

Work Telephone
Room mate contact name (If different from yours)
Relationship to roommate
Address
City, State, Zip
Home Telephone
Work Telephone

 

Travel Data

Accommodations: Twin Double
Program fee based on double occupancy.

Initial Trip Cost $1950

Denali National Park Extension $1100
Total                                    

Payment

Make all checks payable to Cross-Continental Travel and mail to:
Donna Frazer-Palmer/Cross-Continental Travel
34 Wright Court
Lakewood, CO 80228

Timetable

$500 deposit by March 15, 2008. Balance of $1450 due April 30, 2008. Denali Extension $1100 due May 30, 2008.

Release and Agreement


Don't forget to "sign" and submit your application.
By submitting this application you agree that you have read and fully understand the "Release and Agreement" and the "Booking Conditions" as supplied herewith, and agree to be bound hereby, and to comply therewith.

Signature Date


For information call (303) 988-5304 | cell (303) 519-9119 | fax (303) 327-8598 or email donna@crosscontinentaltravel.com.