EmailMe Form - Dance Escape 2023 Credit Card Authorization

Cardholder's Name *

Prefix First Last

Legal name as on government issued identification.

Date of Birth *

MM / DD / YYYY

Please enter Date of Birth for Primary Passenger

Billing Address *

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

Please enter the address that is on file with the card.

Cardholder Phone # *

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

Email *

This will be used for mailing any electronic documents/itineraries.

Who referred you to Dance Escape 2023 *

Please select the person(s) who referred you to Dance Escape 2023. If no one referred, you please select NONE.

Cabin Selection *

Please select the cabin category you would like pricing for. Availability is limited

Other Cabin Option

Please enter the type of cabin if you are requesting a category different than what's available at the group rate, such as Single/solo passenger, Deluxe Verandah, Aqua Class, and Suites.

Cabin Mate's Name, Date of Birth, Gender and Email

Please provide roommate's name, date of birth and email address is required in order to book your cabin.

Special Needs (please pick all that apply) *

Food allergy (please specify below)

Special Diet (Diabetic, Celiac, Vegetarian, etc)

CPAP Machine

Other - please specify below

Mobility Issues - Need rental scooter or walker (add'l fee)

None

Special Needs Additional Information

Please provide additional information for the special need selected above

Payment Details

Please provide payment details below

Authorized Amount - Minimum Deposit is $250.00 per person *

$ Dollars . Cents

Payment is amount required today to initiate reservation. (The date of travel, number of paying guests and supplier terms will be factered in computing required deposit amounts.) This amount is included in Total Package Quote provided in Email. You MUST pay the balance in full prior to Final Due Date or if booking within 75 Days of Traveling.

Credit Card *

Authorization of Charges *

I do authorize

As named Cardholder; I Authorize: Michelle Scott with Indulgence Travel to charge my credit card the above amount, as needed to complete the reserved Travel Package account for the Primary Traveler listed above.

Cruise Care Insurance *

Yes, I want to include the insurance quote in my package - prices start at $109.00 per person

No, I decline insurance and understand the lack of insurance can result in the loss of money as well as any possible financial changes should insurance be required during my trip.

Enjoy some peace of mind, no matter what life throws your way. Celebrity Cruises Travel Protection may help protect you before, during and after your voyage with cancellation and interruption benefits, sickness and accident medical services, and baggage protection.

The Celebrity Cruiseline's Travel Protection Program.

The Cancellation Penalty Waiver and Cruise Vacation Cancellation Enhancement Program - non-insurance features provided thru Celebrity Cruises

Allows you to cancel and waives the normally non-refundable cancellation charges if you need to cancel for specified reasons. In addition, CruiseCare® Cancel For Any Reason Cruise Vacation Enhancement make sure that in the event you choose to cancel for a reason not eligible under the plan, at any time up until departure, Celebrity will provide you with a cruise credit equal to 90% of the non-refundable value of your cruise vacation prepaid to Celebrity, for your use towards a future cruise (excluding Flights by Celebrity).

Travel insurance benefits underwritten by Arch Insurance Company

Trip Interruption & Trip Delay: Provides coverage if you can’t start or finish your cruise vacation because you’re sick or hurt, there’s a death in the family, or for another covered reason. For Trip Delays, the plan reimburses up to $500 for covered out-of pocket expenses to catch up to your cruise. For trip interruption the plan covers up to 150% of your total trip cost.

Medical Expense, Evacuation & Repatriation Benefits: Should you become injured or sick during your vacation, the plan reimburses for covered medical expenses for up to one year from the date of your accident or illness. It is important to evaluate your current insurance to ensure that you have adequate medical coverage while you are traveling. Depending on your plan, Medicare and other health insurance providers may not cover expenses incurred outside of the US. Coverage is up to $25,000 for Accident or Sickness Medical Expenses, up to $50,000 for Emergency Evacuation and up to $25,000 for Repatriation.

E24/7 Emergency Assistance4 – non-insurance services provided by CareFree Travel Assistance: Provides 24-hour travel assistance, medical assistance and emergency services, such as: pre-trip health, safety, and weather information, assistance with travel changes, lost luggage assistance, emergency cash transfer assistance, medical consultation, emergency legal, medical and dental assistance and more.

Terms and Conditions *

I agree to the terms and conditions shown below - including vaccine requirements

I do not agree to the terms and conditions listed below. - STOP HERE and contact Indulgence Travel

Please review Celebrity Cruises Healthy at Sea program.

Healthy at Sea Protocols
Where local government regulations differ, we will comply with local requirements. We will continually evaluate and update these requirements and protocols as new information becomes available. Booked guests will be advised of the latest requirements leading up to departure.

Please be aware of both homeport country travel requirements and Celebrity Cruises requirements as they may differ. We are continually updating this information. Guests will also be notified of the latest requirements leading up to departure via email. Please be sure to register for a guest account so we have your contact information.

Vaccines

All crew and guests who are eligible to be vaccinated must be fully vaccinated with all initial doses administered at least 14 days prior to sailing. COVID-19 Booster Vaccine shots are not required to sail on Celebrity Cruises.

NOTICE: Proof of vaccination will be recorded and may be reviewed for signs of fraud. Unauthorized use of an official government agency seal such as the Centers for Disease Control and Prevention seal is a federal crime, and will be reported to the relevant government authorities.

Testing & Screening

All vaccinated guests must present a negative COVID-19 test result taken as either as an Antigen or PCR test conducted within two days of embarkation and complete a health questionnaire prior to sailing. All unvaccinated children between the ages of two and eleven years old, will be required to bring a negative PCR test result conducted within three days of embarkation. An additional COVID-19 Antigen test will be administered in the terminal before boarding and on the day before disembarkation

The CDC has advised unvaccinated guests cannot be tested twice in one day as it may affect the accuracy of the test results, therefore the COVID-19 test required before arriving at the terminal cannot be taken on boarding day.

All fully vaccinated guests requiring a COVID-19 test to return to their home country will be provided the opportunity to receive testing in the cruise port during disembarkation. Proof of return travel scheduled within 24 hours of disembarkation will be required. Details on testing registration will be provided onboard. Testing will be complimentary for guests with cruise reservations booked prior to November 16, 2021. For new bookings made on or after November 16, 2021, testing will be available for a per person fee. The cost for onsite cruise port testing starts at $99* per person. Prices vary by port and test type.

View Vaccine & Testing FAQ’s: https://www.celebritycruises.com/healthy-at-sea/faqs#testing-and-screening-faqs

Electronic Signature *

Clear

Please use your mouse or mouse pad to draw your signature.