Cruise Booking Enrollment Form

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					GalaxSea Cruises & Travel
A division of Vagabond Travel (since 1971) 3048 Highway 35, Hazlet, NJ 07730 Local 732-335-1000 sellcruises@aol.com

www.GalaxSeaNJ.com

1-800-331-SAIL (7245)

Cruise Booking Enrollment Form WOBM 1160-AM has once again sponsored a cruise hosted by Bob & Marianne 10-Day Southern Caribbean Cruise January 24, 2010, Norwegian Gem
Please sign me (us) up for this truly exciting 10-day Southern Caribbean Cruise round trip New York City. The category stateroom that I (we) am (are) requesting is________. My (our) second choice is category_______. This stateroom will be occupied as a________ (double, single, triple, quad).

It is very important to use your exact “legal” name as printed on your passport.
Traveler #1: Name(s):(Last)_____________________,(First)__________________, (middle),_________________(title)_________(Mr., Mrs., Ms., Dr., etc.) On my “nametag” I prefer ____________(first name, or nick name). Mailing address: _____________________________________________________________ _____________________________________________________________ Telephone(s)_______________________(home, work, cell) E-mail address__________________________ Emergency number________________emergency contact___________ Birth Date________________________ Traveler #2: Name(s):(Last)_____________________,(First)____________________, (middle),_________________(title)_________(Mr., Mrs., Ms., Dr., etc.) On my “nametag” I prefer _______________(first name, or nick name). Mailing address: _____________________________________________________________ _____________________________________________________________ Telephone(s)___________________(home, work, cell) E-mail address___________________________________________ Emergency number______________emergency contact___________

Birth date_________________ Do you have any physical limitations or conditions that should be noted on your record? (i.e. pacemaker, asthma, wheel chair, special medication or treatment required during the cruise, etc…). _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Are you a past passenger of Norwegian Cruise Lines? ___yes, ____no If yes, please provide your Latitude numbers; ______________________________________________________ _____________________________________________________________ Additional information and special requests:

A full deposit is required to sign up for this cruise. Checks should be made out to “GalaxSea Cruises & Travel” and remitted to the above address along with this completed form. Or, if you prefer GalaxSea Cruises & Travel will be happy to process your credit card. We will send you back a letter of confirmation. . Credit card type________________(MasterCard, Visa, AMEX, Discover) Credit card number_____________________________exp.________ Name as it appears on card______________________________________ Billing Address (if different than above)_____________________________ ____________________________________________________________ I ________________agree to pay a total of $___________per person for the above referenced cruise based on category_____. I understand that at the sole discretion of GalaxSea Cruises & Travel, this total agreed amount may be broken down and processed in parts by other vendors involved with this cruise. These may include the cruiseline, insurance company, travel agency, or other related vendor(s). If you will be using more than one credit card per cabin, please identify whose card needs to be charged along with the pertinent information. _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

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Do you live in an adult community? If yes, what is the name? _______________________________________________________ _______________________________________________________ If there are at least 16 residents from your community who have booked within our group we will have a bus for you (providing your community gives permission). If you don’t live in an adult community or you do not have 16 people, which bus location do you prefer? _____ _____ Toms River Park & Ride Harrogate Lifecare, Lakewood

In the event you must cancel this cruise vacation, Travelex Group policy (included with these rates) will reimburse you in US dollars for any cancellation fees imposed by the cruise line (see brochure for cancellation fee schedule) instead of just providing you with cruise credits. This policy provides you with coverage in the event a medical doctor advises you not to travel. It applies to you, an immediate family member, or your traveling companion including most pre-existing medical conditions (see policy for details on coverage). Our agency charges $100 per person administrative fee if you cancel your cruise at any time prior to sailing. Insurance will reimburse this fee too if you cancel for an approved reason. Norwegian Cruise Lines posts their rules, regulations, rights of passage, as well as their cancellation policies in their brochure, and on their web pages (www.ncl.com), which is my responsibility to review. I further understand that it is the intention of Bob & Marianne Levy to personally escort this cruise. However, in the event that they are not able to cruise for any reason, I will not hold GalaxSea Cruises & Travel, Vagabond Travel, WOBM, WADB, Millennium Radio Group LLC or affiliates liable for a refund in whole or partial. Agreed: __________________________________ Date: _________

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