Mid Atlantic Monument Builders 2009 Convention - Passenger Booking Form

Legal Name (as appears on passport): __________________________________Birth date: ___________

Mailing Address: ___________________________________________________________________

City: ____________________________________  State: ______________ Zip: _________________

Home Phone (         ) _______________________  Work Phone (        )________________________

2nd Passenger Legal Name:____________________________________  Birth date: ____________

3rd Passenger Legal Name: ____________________________________ Birth date:_____________

4th Passenger Legal Name: ____________________________________ Birth date: _____________


Email Address(s): ____________________________________________________________________

Emergency Contact Name: _______________________________ Phone (          ) _________________

US Citizen?  Yes or No   If No, Citizenship: ________________________________________________

RCCL Past Guest #'s (if applicable): ___________________ Celebrity or Azamara past guest # if applicable? _________

Any Special Needs:_____________________________ Any Special Occasions:____________________

Stateroom Category Requested
(circle one)   Inside   Oceanview   Balcony   Suite (Category)______________

Tampa Hotel Stay for 1-9-09 and one way transfer back to airport upon return (price tbd):  Yes or No

Or for those flying in the day of sailing
Round trip transfers to airport on 1-10-09 and back 1-15-09 ($39pp)  Yes  or  No

Credit Card number:_____________________________  Expiration Date: _______  Security Code:______

Name as it appears on the card:___________________________________________________________

Amount to be charged: $_______________________  Signature:_________________________________

If paying by check:
Checks are to be made payable to "CruisOne" and are subject to electronic deposit.

Jack Greenawalt's CruiseOne Agency/GPI Marketing
1000 North Front Street
Suite 240
Wormleysburg, PA 17043
Phone: 717-777-0060
Fax: 717-777-0061
Toll Free: 800-757-2784
jgreeenawalt@cruiseone.com