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Kiskadee Antigua Getaway - Trip Registration Form
Let's Travel Together to Antigua! This required form is to be completed for any new land or land/air travel package purchased through Kiskadee Worldwide Travel, LLC. The travel dates for your Antigua getaway are September 15-20, 2022.
Kiskadee Worldwide Travel, LLC is an approved travel agency authorized to conduct business with all travel suppliers including, but not limited to airlines, hotels, cruise lines, tour operators, and travel insurance companies. It is required that you comply with our credit card acceptance policies. You should read and complete this form in its entirety if you are using a credit card to purchase travel services for yourself or other individuals known to you. The purpose of this credit card form is to comply with credit card acceptance rules with travel suppliers and to protect you, the cardholder, and Kiskadee Worldwide Travel, LLC from credit card fraud.
TRAVELER INFORMATION
Lead Traveler Name (As Shown on Passport or Govt. ID)
*
First
Middle
Last
Passport for International Travel/Government ID for Domestic Travel
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Mailing Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Phone
*
###
-
###
-
####
Email
*
Passport Number
NOTE: COMPLETE THIS SECTION ONLY IF PURCHASING AIR
Passport Issuing Authority
Passport Issue Date
MM
/
DD
/
YYYY
Passport Expiration Date
MM
/
DD
/
YYYY
Airline
Please select
Southwest
American Airlines
Delta Airlines
United Airlines
JetBlue
Spirit
Airline Frequent Flyer Program #
Known Traveler Number
Traveler #2 (As Shown on Passport or Govt. ID)
First
Middle
Last
Date of Birth
MM
/
DD
/
YYYY
Gender
Male
Female
Phone
###
-
###
-
####
Email
Passport Number
Passport Issuing Authority
Passport Issue Date
MM
/
DD
/
YYYY
Passport Expiration Date
MM
/
DD
/
YYYY
Airline
Please select
Southwest
American Airlines
Delta Airlines
United Airlines
JetBlue
Spirit
Airline Frequent Flyer Program #
Known Traveler Number
Traveler #3 (As Shown on Passport or Govt. ID)
First
Middle
Last
Date of Birth
MM
/
DD
/
YYYY
Gender
Male
Female
Email
Phone
###
-
###
-
####
Passport Number
Passport Issuing Authority
Passport Issue Date
MM
/
DD
/
YYYY
Passport Expiration Date
MM
/
DD
/
YYYY
Airline
Please select
Southwest
American Airlines
Delta Airlines
United Airlines
JetBlue
Spirit
Airline Frequent Flyer Program #
TRIP DETAILS
Destination
Resort Name
Check-In Date
MM
/
DD
/
YYYY
Check-Out Date
MM
/
DD
/
YYYY
Room Type
Please select
Jr Ste Bay View
Diamond Club Jr Ste Bay View
Diamond Club Jr Ste Swim Out
Bedding
Please select
King
Two Double Beds
Special Requirements/Celebrations (i.e., accessible room, birthday or anniversary)
Emergency Contact
First
Last
Emergency Contact Phone Number
###
-
###
-
####
Travel Protection (Optional/Highly Recommended)
*
Please select
Accept: I would like travel protection
Decline: No, I do NOT want travel protection
If Travel Protection is accepted, full payment is due at time of booking. The this affirms that the traveler has reviewed the policy coverage and accepts that the policy meets the desired protection. The traveler understands that the insurance premium is non-refundable.
If Travel Protection is declined, the traveler acknowledges that you have been offered travel protection and by declining you are responsible for any expenses incurred by or resulting from cancellation/delays, accidents, sickness, death, stolen or damaged property. The traveler is waiving access to any travel protection coverages.
BILLING
Cardholder Name
*
First
Middle
Last
Credit Card Type
*
Please select
Visa
Mastercard
Discover
American Express
Authorized Amount
*
$
Dollars
.
Cents
Credit Card
*
Card Number
Expiration
MM
/
YY
CVV
What is this?
3 or 4 digit number printed on the back/front of your credit card
Protected in vault
Data collected via fields that have our security seal are encrypted and stored with the highest global security standard — PCI compliance. Your data is absolutely safe in Vault.
Cardholder Telephone Number
*
###
-
###
-
####
Cardholder Billing Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Approval of Charges
*
As named cardholder, I authorize my credit card to be charged immediately for the above amount, as needed to meet the requirements of my vacation experience. Please note payment will be processed within 48 hours.
TERMS AND CONDITIONS
*
CLICK HERE TO AGREE TO TERMS AND CONDITIONS
All reservations will be created based on information submitted on this form. Kiskadee Worldwide Travel, LLC and/or travel agents associated with this agency are not responsible for errors entered by the client. It is imperative that you provide information directly from your passport or government issued ID to avoid errors on your reservation. Any fees incurred as a result of incorrect information entered on this form is the sole responsibility of the client.
Payment Authorization Date
*
MM
/
DD
/
YYYY