If you have ANY difficulties in completing this form, please contact Tracy, Ann or Cece at Flying Dutchmen Travel at (707) 546-1212, and we will be happy to assist you.
* = required field |
NAME OF PASSENGER #1:
Please write your name as it appears on your valid passport (first and last name only). |
* Mr.
Mrs.
Ms.
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* FIRST NAME: |
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* LAST NAME: |
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* MAILING ADDRESS: |
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* CITY: |
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STATE: |
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* ZIP: |
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DAY PHONE: |
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EVENING PHONE: |
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* E-MAIL: |
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DATE OF BIRTH: |
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/
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COUNTRY OF CITIZENSHIP: |
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| FORM OF PAYMENT: Credit Card:
| Check:
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Card Number: |
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EXP Date:
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If paying by check, please provide the following information: |
Check Number: |
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| Air Gateway City: |
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Please specify. If you are not flying type "none" |
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No Air Required: |
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T-SHIRT:
Men's: S
| M
| L
| XL
| XXL
Women's: S
| M
| L
| XL
| XXL
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NAME OF PASSENGER #2:
Please write your name as it appears on your valid passport (first and last name only). |
| Mr.
Mrs.
Ms.
|
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PASSENGER 2
FIRST NAME: |
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PASSENGER 2
LAST NAME: |
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MAILING ADDRESS: |
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CITY:
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STATE: |
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ZIP: |
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DAY PHONE: |
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EVENING PHONE: |
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E-MAIL: |
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DATE OF BIRTH: |
/
/
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COUNTRY OF CITIZENSHIP: |
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| FORM OF PAYMENT: Credit Card:
| Check:
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Credit Card type |
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Card Number |
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EXP Date: |
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|
|
If paying by check, please provide the following information |
Check Number |
|
| Air Gateway City: |
|
|
Please specify. If you are not flying type "none" |
|
NO AIR REQUIRED: |
|
T-SHIRT:
Men's: S
| M
| L
| XL
| XXL
Women's: S
| M
| L
| XL
| XXL
|
NAME OF PASSENGER #3:
Please write your name as it appears on your valid passport (first and last name only). |
Mr.
Mrs.
Ms.
|
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FIRST NAME: |
|
LAST NAME: |
|
MAILING ADDRESS: |
|
CITY: |
|
STATE: |
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ZIP: |
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DAY PHONE: |
|
EVENING PHONE: |
|
E-MAIL: |
|
|
|
DATE OF BIRTH: |
/
/
|
COUNTRY OF CITIZENSHIP: |
|
| FORM OF PAYMENT: Credit Card:
| Check:
|
|
|
Card Number: |
|
EXP Date:
|
|
|
|
If paying by check, please provide the following information: |
Check Number: |
|
| Air Gateway City: |
|
|
Please specify. If you are not flying type "none" |
|
No Air Required: |
|
T-SHIRT:
Men's: S
| M
| L
| XL
| XXL
Women's: S
| M
| L
| XL
| XXL
|
NAME OF PASSENGER #4:
Please write your name as it appears on your valid passport (first and last name only). |
| Mr.
Mrs.
Ms.
|
|
PASSENGER 2
FIRST NAME: |
|
PASSENGER 2
LAST NAME: |
|
MAILING ADDRESS: |
|
CITY:
|
|
STATE: |
|
ZIP: |
|
DAY PHONE: |
|
EVENING PHONE: |
|
E-MAIL: |
|
|
|
DATE OF BIRTH: |
/
/
|
COUNTRY OF CITIZENSHIP: |
|
| FORM OF PAYMENT: Credit Card:
| Check:
|
Credit Card type |
|
Card Number |
|
EXP Date: |
|
|
|
If paying by check, please provide the following information |
Check Number |
|
| Air Gateway City: |
|
|
Please specify. If you are not flying type "none" |
|
NO AIR REQUIRED: |
|
T-SHIRT:
Men's: S
| M
| L
| XL
| XXL
Women's: S
| M
| L
| XL
| XXL
|
|
| Number of Passengers in your cabin *: 1
2
3
4
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Other passengers not in your cabin, with whom you would want to dine with or have cabins located close by (*KZST WILL DO EVERYTHING POSSIBLE TO PUT CABINS IN PROXIMITY, BUT CANNOT GUARANTEE PLACEMENT IN EITHER CABINS, DINNER SEATING, OR AIRLINE SCHEDULE):
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TYPE OF CABIN *:
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| DINING *: EARLY
LATE:
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| TABLE SIZE: S
M
L
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| If you will not be attending the pre-cruise document party and would like your documents mailed to you, please click here:
( Should you not be able to attend our pre-cruise document party then there is a $15.00 per address fee for sending your documents.) |
| Medical Conditions: Wheelchair
Diabetes
Other
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