CRUISE REGISTRATION FAX FORM

FAX TO: (617) 298-7349 E-MAIL TO: PROCESS@KIQTOURS.COM Group Leader:KIQ Tours

TRIP NAME: ____________________________________________________ CONFIRMATION #________________________________(IF APPICIABLE)

Primary Traveler Name:

NAME ____________________________________________________________________________________ TEL #:____________________________________

ADDRESS________________________________________________________CITY______________________ STATE__________ ZIP CODE_______________

E-MAIL ADDRESS____________________________________________________________________________________________________________________

Cabin Type: Inside Cabin□ Ocean View Cabin□ Balcony Cabin□ Suite Cabin□

Package Options: Air□ Pre-Cruise Hotel□ Post-Cruise Hotel□ Gratuity□ Transfers□ Insurance□

IMMIGRATION TRAVEL INFORMATION: (Required To Travel)

NUMBER OF GUEST IN ROOM INCLUDING YOURSELF: (CHECK ONE) □ 1 Single □ 2 Double □ 3 Triple □ 4 Quadruple

Your Name_____________________________________________DOB_______________Sex________Citizenship______________Air City__________________

Roommate #1 Name______________________________________DOB_______________Sex________Citizenship______________ Air City__________________

Roommate #2 Name______________________________________DOB_______________Sex________Citizenship______________ Air City__________________

Roommate #3 Name______________________________________DOB_______________Sex________Citizenship______________ Air City__________________

T-shirt Size: SM_______ M______ L______ XL______ XXL______ 3X______ 4X______

PAYMENT OPTIONS:

Credit Card: AMEX DISCOVER MASTERCARD VISA

ACCOUNT #:___________________________________________________ EXP. DATE___________CVV2 #___________, (3 Digit # Back of D/MC/V Card)

(4 Digit # Front Right Amex Card)

Check Payment:

BANK NAME____________________________________________________________________CHECK#____________

ROUTING#:________________________________ACCOUNT#___________________________________________

Payment For:

Yourself _________________________________________________________________ AMT $__________________□ Deposit □ Payment

Roommate #1 _____________________________________________________________ AMT $__________________□ Deposit □ Payment

Roommate #2 _____________________________________________________________ AMT $__________________□ Deposit □ Payment

Roommate #3 _____________________________________________________________ AMT $__________________□ Deposit □ Payment

Total Amount To Charge AMT $__________________

SIGNATURE._______________________________________________________________________________________ DATE___________________________

(I hereby authorize KIQ Travel Services D/B/A KIQ Tours and/or Carnival Cruise Lines to charge or debit my account in the above amount for travel. Furthermore in the event that I cancel my travel arrangements after

the cancellation date prescribe by the terms and conditions of this tour. I authorize the above mentioned companies to hold my account liable for the charges due as a cancellation fee and authorize them to refund only the

portion due back to me if applicable.)

(FOR OFFICE USE ONLY)

AUTHORIZATION No.____________________________ ORDER TAKEN BY:___________________