PRE-REGISTRATION FORM Please complete and return this form to reserve your space on an upcoming cruise with Oceania Cruises or Regent Seven Seas Cruises. Please complete and send to:
PLEASE INDICATE ASSOCIATION/GROUP NAME:
8000 West 78th Street, Suite 345 Minneapolis, MN 55439-2538 800-842-9023 • 952-918-8950 Fax: 952-918-8975
PLEASE RESERVE SPACE FOR: Cruise Name
Departure Date
p CRUISE PROGRAM WITH AIRFARE Please indicate preferred departure city: Stateroom/Suite category requested: 1st choice
2nd choice
p CRUISE PROGRAM ONLY Bed Request p Twin (2 beds) p Queen
Single and Triple accommodations are an additional cost and subject to availability. Request: p Single p Triple Full Name (as it appears on your passport)
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First Middle Last Title Full Name (as it appears on your passport)
Birth Date
First Middle Last Title
Birth Date
(MM/DD/YYYY)
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(MM/DD/YYYY)
Email Address Mailing Address City Home Phone
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Cell Phone
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State
ZIP
Roommate (if different from above)
DEPOSIT: A deposit of $850 per person is required to pre-register for this sailing. To finalize your registration, you will need to submit a
completed reservation form located in the full brochure which will be mailed to you approximately 11 months prior to departure. Your $850 deposit is fully refundable prior to submitting a completed reservation form from the full brochure. Make checks payable to Go Next. Deposits may also be made by credit card, however, your credit card may not be charged until the completed reservation form from the full brochure is received by Go Next. I/We authorize Go Next, Inc. to charge my/our deposit for $ _____________________ to: p Visa p MasterCard
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Exp. Card Security Number ________________________________________________________________________ Code ______________ Date ______________________ Name (as it appears on your credit card) __________________________________________________________________________________________________________ p Billing address SIGN HERE X __________________________________________________________________________________________________ same as above Billing Address (if different from above) _______________________________________________________________________________________________________
LIMITED AVAILABILITY! SIGN UP NOW TO RESERVE YOUR SPACE! Call for additional information: 800-842-9023 or 952-918-8950 Fax: 952-918-8975 www.GoNext.com