GUEST 1
Name must match legal documentation (Driver's License, Passport, Birth Certificat,etc). You will
not be allowed to board unless your name matches exactly. For example: If Robert Smith is printed on your Passport, DO NOT enter "Bob Smith"
Last Name (as it appears on your Passport)
Referred by Whom
Date of Birth
Email
Mobile Phone Number
Emergency Contact Number
Address Line 1
Address Line 2
City, State, Zipcode
Hotel-Only Pkg = $900
Name on Credit Card (exactly as it appears)
Type of Card (Visa, MC, AMEX, Diners)
Credit Card Number
Credit Card Expiration (Month and Year)
Security Code (on back of card)
Pay in full? (Specify if you want to charge the FULL AMOUNT NOW. $100 Discount applies.)
List any Medical Needs (wheelchair accessibility, pregnancy, medication, etc)
Special Requests (handicap access, excursions, room upgrades, etc)
Comments
Other Vacation Destinations you're interested in?
GUEST 2 Name must match legal documentation (Driver's License, Passport, Birth Certificat,etc). You will
not be allowed to board unless your name matches exactly. For example: If Robert Smith is printed on your Passport, DO NOT enter "Bob Smith"
Last Name (as it appears on your Passport)
Date of Birth
Email
Mobile Phone Number
Emergency Contact Number
Same Address as Above
Address Line 1
Address Line 2
City, State, Zipcode
Hotel-Only Pkg = $900
Same Credit Card as Above
Name on Credit Card (exactly as it appears)
Type of Card (Visa, MC, AMEX, Diners)
Credit Card Number
Credit Card Expiration (Month and Year)
Security Code (on back of card)
Pay in full? (Specify if you want to charge the FULL AMOUNT NOW. $100 Discount applies.)
List any Medical Needs (wheelchair accessibility, pregnancy, medication, etc)
Special Requests (handicap access, excursions, room upgrades, etc)
Commments
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* I understand the package price is PER PERSON. (unless otherwise discussed with Travel Coordinator) .
After clicking the 'Submit' button, please allow
for a few seconds for the profile to be sent to our email address. (1) If you do not receive a screen confirming your form was accepted -or- (2) If you do not receive
an email confirming the content you typed in, please call us immediately at 919-827-5713. In either of these cases, its likely we did not receive your reservation request.
I certify that I have read all terms & agreements on the website. I have reviewed the payment amounts and the schedule and will comply with the payment arrangements posted.
I agree to the terms aforementioned and agree to The A List processing my credit card
per the payment schedule.
I approve The A List to process my non-refundable security deposit TODAY.Payment Schedule , unless otherwise stated. .
