If you have ANY difficulties in completing this form, please contact Tracy, Ann or Mona at 707-546-1212 / 800-376-2504, and we will be happy to assist you.

* = required field

NAME OF PASSENGER #1:
Please write your name as it appears on your proof of citizenship.
* Mr. Mrs. Ms.
* FIRST NAME:
* LAST NAME:
* MAILING ADDRESS:
*  CITY:
STATE:
*  ZIP:
DAY PHONE:
EVENING PHONE:
* E-MAIL:
 
DATE OF BIRTH:
/ /
COUNTRY OF CITIZENSHIP:
FORM OF PAYMENT: Credit Card: | Check:

Credit Card type:
Card  Number:
EXP Date:
 
If paying by check, please provide the following information:
Check Number:
Air Gateway City:    
Please specify. If you are not flying type "none"
 No Air Required:

T-SHIRT:
Men's: S | M | L | XL | XXL HAT

NAME OF PASSENGER #2:
Please write your name as it appears on your proof of citizenship.
Mr. Mrs. Ms.   
PASSENGER 2
FIRST NAME:
PASSENGER 2
LAST NAME:
MAILING ADDRESS:
 CITY:
STATE:
 ZIP:
DAY PHONE:
EVENING PHONE:
E-MAIL:
 
DATE OF BIRTH:
/ /
  COUNTRY OF CITIZENSHIP:
   
FORM OF PAYMENT: Credit Card: | Check:   
  Credit Card type
Card Number
EXP Date:
 
If paying by check, please provide the following information
Check Number
Air Gateway City:    
Please specify. If you are not flying type "none"
 NO AIR REQUIRED:

T-SHIRT:
Men's: S | M | L | XL | XXL HAT

NAME OF PASSENGER #3:
Please write your name as it appears on your proof of citizenship.  
Mr. Mrs. Ms.
 
FIRST NAME:
LAST NAME:
MAILING ADDRESS:
CITY:
STATE:
ZIP:
DAY PHONE:
EVENING PHONE:
E-MAIL:
 
DATE OF BIRTH:
/ /
COUNTRY OF CITIZENSHIP:
FORM OF PAYMENT: Credit Card: | Check:

Credit Card type:
Card  Number:
EXP Date:
 
If paying by check, please provide the following information:
Check Number:
Air Gateway City:    
Please specify. If you are not flying type "none"
 No Air Required:

T-SHIRT:
Men's: S | M | L | XL | XXL HAT

NAME OF PASSENGER #4:
Please write your name as it appears on your proof of citizenship.
Mr. Mrs. Ms.   
PASSENGER 2
FIRST NAME:
PASSENGER 2
LAST NAME:
MAILING ADDRESS:
 CITY:
STATE:
 ZIP:
DAY PHONE:
EVENING PHONE:
E-MAIL:
 
DATE OF BIRTH:
/ /
  COUNTRY OF CITIZENSHIP:
   
FORM OF PAYMENT: Credit Card: | Check:   
  Credit Card type
Card Number
EXP Date:
 
If paying by check, please provide the following information
Check Number
Air Gateway City:    
Please specify. If you are not flying type "none"
 NO AIR REQUIRED:

T-SHIRT:
Men's: S | M | L | XL | XXL HAT

Number of Passengers in your cabin *: 1  2  3  4   
Stateroom Description & Pricing Info
Cabin Type Our Per Person Price
Interior Stateroom $699.00
Oceanview Stateroom $899.00
Deluxe Balcony Stateroom $1099.00
Superior Balcony Balcony $1199.00
 

Rates are per person, based on double occupancy. Government fees $159.00pp / Fuel Surcharges $134.46pp and subject to change / Deposit is $300.00 per person and subject to a $50.00 per person cancellation fee upon booking. Other Terms and Conditions Apply - Contact Flying Dutchmen Travel for information. Any cancellations on or after January 21, 2009 will result in loss of full deposit. Final payment is July 1 , 2009.


TYPE OF CABIN *:

DINING *: EARLY  LATE:
TABLE SIZE: S  M  L  
Medical Conditions:   Wheelchair   Diabetes Other
Optional Insurance
Highly Recommended
Travel Insurance.We strongly urge you to protect your investment. Cancellation penalties apply! We will send you a Travel Guard Insurance form for you to fill out and mail directly to Travel Guard upon our receipt of your cruise deposit.

IMPORTANT

I HEREBY AUTHORIZE THE ABOVE CREDIT CARD TO BE CHARGED FOR THE CRUISE PACKAGE I HAVE PURCHASED.

BY SUBMITTING THIS ON-LINE APPLICATION I ACKNOWLEDGE THAT I UNDERSTAND I (WE) MUST BRING PROPER PROOF OF CITIZENSHIP AS REQUIRED BY THE GOVERNMENT AS DESCRIBED ON THE WEB SITE FOR THIS CRUISE, OR I (WE) WILL NOT BE ALLOWED TO BOARD THE SHIP AND NO REFUND WILL BE ISSUED.

IF YOU ARE MAILING A CHECK, PLEASE MAKE IT PAYABLE TO:
FLYING DUTCHMEN TRAVEL
Mail Checks to:
Flying Dutchmen Travel
2245 Montgomery Dr,
Santa Rosa, CA 95405
information@flyingdutchmentravel.com
707-546-1212 / 800-376-2504

*My Name
* Today's Date
Please click on "SUBMIT" to submit your request for a reservation.