. $ . . 0 $. 2,;;,905. <50=,9:0;@ (3<450 (::6*0(;065 October 10 - 18, 2013
$ 5 8000 West 78th Street, Suite 345 Minneapolis, MN 55439-2538 800.842.9023 â&#x20AC;˘ 952.918.8950 Fax: 952.918.8975
Class Year
73,(:, 4(2, 4@ 6<9 9,:,9=(;065 -69! S CRUISE PROGRAM WITH AIRFARE Please indicate preferred departure city: __________________________ S CRUISE PROGRAM ONLY (Air credit of $850 per person) Stateroom/Suite category requested: 1st choice _____________ 2nd choice _____________ Bed request: S Twin (2 beds) S Queen Single and Triple accommodations are an additional cost and subject to availability. Request: S Single S Triple S Please reserve _____________ space(s) for the GO NEXT FRENCH RIVIERA PRE-CRUISE PROGRAM, $699 per person, double occupancy. Single occupancy is $874 and subject to availability. (SS WHZZLUNLYZ T\Z[ [YH]LS ^P[O H WHZZWVY[ ]HSPK H[ SLHZ[ TVU[OZ IL`VUK [OLPY YL[\YU KH[L Full Name (as it appears on your passport)
First
Middle S M Birth Date S F (MM/DD/YYYY)
Preferred name on name badge
Last
_ _
Title
Citizenship
Full Name (as it appears on your passport)
First
Middle S M Birth Date S F (MM/DD/YYYY)
Preferred name on name badge
Last
_ _
Title
Citizenship
Email Address Mailing Address City Home Phone
State
_
Cell Phone
ZIP
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Oceania Cruises Club Number (past cruise travelers only) Roommate (if different from above) Adjacency Request
+,76:0; (5+ -05(3 7(@4,5;! A deposit of $850 per person (plus a $200 deposit per person for the Pre-Cruise Program, if applicable) is due with your reservation application. Make checks payable to .V 5L_[. Full payment is required by July 2, 2013 (100 days prior to departure). Reservations received after this date must be accompanied with full payment. Please reserve _____________ space(s) and enclosed is my/our deposit for $ _____________________. Deposits may also be made by credit card; however, HSS -05(3 WH`TLU[Z HYL YLX\PYLK [V IL THKL I` JOLJR VY JHZO 0 >L H\[OVYPaL .V 5L_[ 0UJ [V JOHYNL T` V\Y KLWVZP[ MVY _____________________ [V! S Visa S MasterCard Card Security Exp. Number _________________________________________________________ Code ____________ Date ___________ Name (as it appears on your credit card) ____________________________________________________________________________________
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S Billing address same as above
Billing Address (if different from above) _________________________________________________________________________________
:0.5(;<9,: 9,8<09,+ )@ ,(*/ 7,9:65 ;9(=,305. INCLUDING PARENT/GUARDIAN FOR MINOR CHILDREN: I/We have read, received a copy of, understand, and accept the terms and conditions stated in the Operator/Participant Agreement. :0.5 /,9, ? :0.5 /,9, ? Making a deposit or acceptance or use of any vouchers, tickets, goods, or services shall be deemed consent to and acceptance of the terms and conditions stated in the applicable Operator/Participant Agreement, including limitations on responsibility and liability. ;YH]LS PUZ\YHUJL PZ H]HPSHISL HUK JHU WYV]PKL JV]LYHNL MVY \UMVYLZLLU JPYJ\TZ[HUJLZ [OH[ JV\SK KPZY\W[ `V\Y [YPW :LL ;YH]LS 0UZ\YHUJL WHULS MVY KL[HPSZ
73,(:, 05*3<+, ;9(=,3 .<(9+ ;9(=,3 05:<9(5*,! S 5VU YLM\UKHISL WYLTP\T WH`TLU[ LUJSVZLK S 7SLHZL PU]VPJL TL \Z MVY [OL WH`TLU[ Please select the appropriate premium amount based upon the total per person cost of travel services purchased from Go Next.
S $7,001 - $7,500 = $539 S $5,001 - $5,500 = $399 S $3,001 - $3,500 = $259 S $1,001 - $1,500 = $109 S $7,501 - $8,000 = $579 S $5,501 - $6,000 = $439 S $3,501 - $4,000 = $289 S $1,501 - $2,000 = $149 S $8,001 - $8,500 = $619 S $6,001 - $6,500 = $459 S $4,001 - $4,500 = $329 S $2,001 - $2,500 = $189 S $6,501 - $7,000 = $499 S $4,501 - $5,000 = $359 S $2,501 - $3,000 = $229 S $8,501 - $9,000 = $659 050;0(3 /,9, 0- @6< >0:/ ;6 +,*305, ;9(=,3 .<(9+ ;9(=,3 05:<9(5*,!