EmailMe Form - Group Registration Form

One Resgistration Form Per Room

Passanger 1 *

First MI Last

Passenger 1 Email *

Phone *

### - ### - ####

Passenger 1 Date of Birth *

Name & Phone Number

Passanger 2

First MI Last

Passenger 2 Email

Passenger 2 Date of Birth

Name & Phone Number

Phone

### - ### - ####

Passanger 3

First MI Last

Passenger 3 Email

Passenger 3 Date of Birth

Name & Phone Number

Phone

### - ### - ####

Accommodations & Travel Dates

Name of Resort *

Room Category *

Arrival Date *

MM / DD / YYYY

Departure Date *

MM / DD / YYYY

Additional Comments/Special Needs

Travel Protection

We strongly recommend the purchase of travel insurance to protect your investment. Please choose an option below. If you elect to purchase insurance you will be contacted with a quote.

Travel Protection *

I wish to purchase travel insurance. I understand that some provisions of travel insurance, such as coverage for pre-existing conditions, may require that insurance be purchased within 10 days of deposit.

I wish to decline travel insurance. By declining travel insurance I am assuming the financial responsibility of any non-refundable penalties should I have to cancel or interrupt my trip.

Payment Authorization

Credit Card

American Express

Discover

Mastercard

Visa

Amount authorizated to debit

Name on the Card

Card Number

Card Expiration Date

MM / DD / YYYY

3 Digit Security Code (4 Digits AMEX)

Billing Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

I certify that I am the authorized user of this credit card and I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form

Yes

No

This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only.

Yes

No

Authorization Date to Debit

Signature