EJ Birthday Cruise Reservation Form

First Passenger First Name *

Last Name *

Date of Birth * +

Gender *

Male

Female

Second Passenger First Name

Second Passenger Last Name

Date of Birth +

Gender *

Male

Female

Third Passenger First Name

Third Passenger Last Name

Date of Birth +

Gender *

Male

Female

Forth Passenger First Name

Forth Passenger Last Name

Date of Birth +

Gender *

Male

Female

Primary Customer Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

If both passengers are paying with separate cards, each person must fill out a separate form. Please identify your roommate on each form.

Once your form has been submitted with Credit or Debit card information, I will process your payment and emai your invoice.

Serenity Travel Experts highly recommends the purchase of Travel Insurance in the event of cancellation or medical emergency. Cost will be determined at the time of booking.

What is the date and name of your cruise?

Travel Insurance *

What is your desired cabin type? *

Balcony $1021.65

Oceanview $836.65

Interior $731.65

Amount of Payment *

Name on Card Primary *

Credit Card Type *

Credit Card Number *

Security Code *

Expiration Date (mm/yy) *

If payment is for anyone other than the card holder, who?

Additional comments.

I authorize Serenity Travel Experts to charge my card.

Signature *

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