Final payments are due 90 days prior to your departure date. Cruise deposit is $400 per person. Your payment method will automatically be charged for final payment unless you notify us that you wish to use a different card. How many travelers are you registering?(Required)123Traveler #1 - Primary ContactPlease provide information for the primary contact. You'll be able to add additional travelers below (make sure you select # of travelers above).Traveler #1 - Name(Required)As it appears on passport. First Middle Last Traveler #1 - Email(Required) Enter name to use for onboard name tag:(Required) Traveler #1 - Date of Birth(Required) MM slash DD slash YYYY Traveler #1 - Phone #(Required)Traveler #1 - Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Traveler #1 - Cruise Loyalty # (if applicable)Enter your loyalty account for points. Traveler #1 - Are You a Repeat Traveler?(Required)How many HIV Cruise Retreats, or trips with us, have you been on?Traveler #2Please provide information for the second person travelling with you.Traveler #2 - Name(Required)As it appears on passport. First Middle Last Traveler #2 - Email(Required) Enter name to use for onboard name tag:(Required) Traveler #2 - Date of Birth(Required) MM slash DD slash YYYY Traveler #2 - Phone #(Required)Traveler #2 - Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Traveler #2 - Cruise Loyalty # (if applicable)Enter your loyalty account for points. Traveler #2 - Are You a Repeat Traveler?(Required)How many HIV Cruise Retreats, or trips with us, have you been on?Traveler #3Please provide information for the third person travelling with you.Traveler #3 - Name(Required)As it appears on passport. First Middle Last Traveler #3 - Email(Required) Enter name to use for onboard name tag:(Required) Traveler #3 - Date of Birth(Required) MM slash DD slash YYYY Traveler #3 - Phone #(Required)Traveler #3 - Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Traveler #3 - Cruise Loyalty # (if applicable)Enter your loyalty account for points. Traveler #3 - Are You a Repeat Traveler?(Required)How many HIV Cruise Retreats, or trips with us, have you been on?Cabin InformationPlease select your cabin preferences below. Prices reflect single / double occupancy. Reservation forms must be submitted, along with final payment 90 days prior to trip departure.Select Cabin Type - First Choice(Required)Pick your first choice for cabin type. Inside Cabin with Perks Ocean View with perks Veranda with Perks Concierge Class with Perks Aqua Class with Perks Select Cabin Type - Second Choice(Required)Pick a choice if the first choice is not available. Inside Cabin with Perks Ocean View with perks Veranda with Perks Concierge Class with Perks Aqua Class with Perks Select # of Beds in Cabin(Required) Queen / King Bed Two Beds Do you require an ADA accessible cabin?(Required) No Yes Would you like to be matched with a cabinmate?(Required) No - I prefer a single and will pay additional charge. Yes Billing InformationPlease provide primary billing information. You can select "Add Additional Payment Method" below to enter add a different form of payment for a cabinmate. Primary - Cardholder Name(Required) First Last Primary - Card Number(Required) Primary - Expiration Date(Required) Primary - Security Code(Required) Do you need to enter an additional payment method?NoYesAdditional Payment MethodPlease provide secondary billing information. Additional Cardholder - Name(Required) First Last Additional Billing - Card Number(Required) Additional Billing - Expiration Date(Required) Additional Billing - Security Code(Required) Trip InsuranceTrip insurance is strongly recommended. It covers various cancellations, trip interruptions, medical expenses / evacuation, trip delays, and baggage insurance. The cost varies depending on your room and trip selection. Details will be provided in your confirmation email. Do you want Trip Insurance?(Required)NoYesI have read, understand, and accept the information regarding cancellations and insurance.(Required)YesNoCredit Card Authorization(Required)I authorize Cruise Designs Travel to charge deposits and final payments to my card. AuthorizeElectronic Signature(Required)Final payment is due 90 days prior to trip date. Your primary payment method will automatically be charged for final payment unless notified of a different form of payment prior to the final payment data. Comments or Questions?
