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Blue Moon Cruise 2019
REGISTRATION FORM
Deposit of $250 per person is fully refundable until the final payment date of October 1, 2018. Prices are person, based on double occupancy and includes all port charges, taxes, fees and prepaid gratuities. Single passengers are 200%. If you are booking as a single enter quantity of 2 for deposit. If you would like to spread out your payments, we are offering a payment plan. Please indicate if you are interested in the payment area at the bottom of the form.
SELECT CABIN/PER PERSON
*Make a Payment
TOTAL:
Passenger #1: Personal Information
*First Name:Exact Name on Passport
*Middle Name:Exact Name on Passport
*Last Name:Exact Name on Passport
*E-Mail:Valid e-mail is required
*Address Line 1:
Address Line 2:
*City:
*State:
*Zip Code:
*Phone:
Gender:
*Date of Birthmm/dd/yyyy
*Citizenship:
*Passport Number:
*Issue Date:mm/dd/yyyy
*Expiration Date:mm/dd/yyyy
*Emergency Contact Name:
*Emergency Contact Phone:
Sharing Cabin With:
*Do you have a 2nd passengers to book?
Yes No 
Passenger # 2: Personal Information
*First Name:Exact Name on Passport
*Middle Name:Exact Name on Passport
*Last Name:Exact Name on Passport
E-Mail:Valid e-mail is required
*Address Line 1:
Address Line 2:
*City:
*State:
*Zip Code:
*Phone:
Gender:
*Date of Birthmm/dd/yyyy
*Citizenship:
*Passport Number:
*Issue Date:mm/dd/yyyy
*Expiration Date:mm/dd/yyyy
*Emergency Contact Name:
*Emergency Contact Phone:
*Do you have a 3rd passengers to book?
Yes No 
Passenger # 3: Personal Information
*First Name:Exact Name on Passport
*Middle Name:Exact Name on Passport
*Last Name:Exact Name on Passport
E-Mail:Valid e-mail is required
*Address Line 1:
Address Line 2:
*City:
*State:
*Phone:
Gender:
*Date of Birthmm/dd/yyyy
*Citizenship:
*Passport Number:
*Issue Date:mm/dd/yyyy
*Expiration Date:mm/dd/yyyy
*Emergency Contact Name:
*Emergency Contact Phone:
*Do you have a 4th passengers to book?
Yes No 
Passenger # 4: Personal Information
*First Name:Exact Name on Passport
*Middle Name:Exact Name on Passport
*Last Name:Exact Name on Passport
E-Mail:Valid e-mail is required
*Address Line 1:
Address Line 2:
*City:
*State:
*Phone:
Gender:
*Date of Birthmm/dd/yyyy
*Citizenship:
*Passport Number:
*Issue Date:mm/dd/yyyy
*Expiration Date:mm/dd/yyyy
*Emergency Contact Name:
Celebrity Captain`s Club #:
Check Payment
Check Payment
Make Check payable to Blue Moon, Inc. Print a copy of this Registration Form and mail to
Blue Moon Cruise
35 Baltimore Avenue
Rehoboth Beach, DE 19971
Credit/Debit Card Payment (via our secure server)
Name on Credit Card:
Card Number:No dashes or spaces please
Expiration Month:From your card
Expiration Year:From your card
Card Type:
Security Code:3- or 4-digit code
Card Mailing Address:
Please send me Payment Plan information
 
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