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Theodore HS Band / Disney March 2018
Traveler Information
*Name of Traveler:
*Choose one:
*Choose one:
*Address Line 1:
Address Line 2:Apt. or Suite No.
*Zip Code:
*E-Mail of Parent:
*Occupancy REQUEST:
Once a rooming list is submitted,each traveler will be billed on his or her room occupancy which could increase the cost of the trip.
*Number of Travelers on this reservationIf more than 1, list below.
List Additional Travelers & Relationship to Primary Traveler:Ex. Lee Smith - Father
Meal Voucher Add-ons
For all breakfast and dinners to be covered, each traveler needs 3 breakfast vouchers and 3 dinner vouchers each.
These are not required and are for an addition cost.
Breakfast vouchers are $13/each
Dinner vouchers are $17/each
*How many breakfast vouchers are you adding @ $13/each?
*How many dinner vouchers are you adding @ $17/each?
Payment Schedule
September 10, 2017 - $175 per person
October 10, 2017 - $135 per person
November 10, 2017 - $135 per person
December 10, 2017 - $135 per person
January 10, 2018 - Balance due
Credit/Debit Card Information
Please refer to the payment schedule above for payment information.

NOTE: A 3.5% fee imposed by the credit card companies will be added to each card transaction.
Once the payment is invoiced, you will receive a receipt via email.
*Amount to charge today:3.5% will be added
*Card Number:Please put dashes between sets
*Name on Card:Please put dashes between sets
*Expiration Month:
*Expiration Year:
*Card Brand:
By submitting this form, you are agreeing to all terms and conditions and no money is refundable or transferable.
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