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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
Choose a Stateroom Type
Ocean View Stateroom - Cat 2N $250.00
Balcony Cabin - Cat GTY $250.00
Junior Suite - Cat J4 $250.00
Grand Suite - Cat GS $250.00
Owner`s Suite - Cat OS $250.00
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:
Choose a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*Zip Code:
*Phone:
Gender:
Select Gender
Male
Female
*Date of Birth
mm/dd/yyyy
*Citizenship:
*Passport Number:
*Issue Date:
mm/dd/yyyy
*Expiration Date:
mm/dd/yyyy
*Emergency Contact Name:
*Emergency Contact Phone:
Celebrity Captain`s Club #:
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:
Choose a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*Zip Code:
*Phone:
Gender:
Select Gender
Male
Female
*Date of Birth
mm/dd/yyyy
*Citizenship:
*Passport Number:
*Issue Date:
mm/dd/yyyy
*Expiration Date:
mm/dd/yyyy
*Emergency Contact Name:
*Emergency Contact Phone:
Celebrity Captain`s Club #:
*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:
Choose a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*Phone:
Gender:
Select Gender
Male
Female
*Date of Birth
mm/dd/yyyy
*Citizenship:
*Passport Number:
*Issue Date:
mm/dd/yyyy
*Expiration Date:
mm/dd/yyyy
*Emergency Contact Name:
*Emergency Contact Phone:
Celebrity Captain`s Club #:
*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:
Choose a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*Phone:
Gender:
Select Gender
Male
Female
*Date of Birth
mm/dd/yyyy
*Citizenship:
*Passport Number:
*Issue Date:
mm/dd/yyyy
*Expiration Date:
mm/dd/yyyy
*Emergency Contact Name:
*Emergency Contact Phone:
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:
Month
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February
March
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May
June
July
August
September
October
November
December
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Expiration Year:
Year
2018
2019
2020
2021
2022
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Card Type:
Choose a Card
American Express
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Security Code:
3- or 4-digit code
Card Mailing Address:
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