100 BLACK MEN OF LAS VEGAS & PHOENIX: REAL MEN GIVING REAL TIME
VALENTINE'S DAY CRUISE FEB. 22 - 28,-2009
GROUP REGISTRATION FORM
Complete and return with your deposit to Cason Travel & Tours, 4610 Cliff Breeze Dr., North Las Vegas, NV. 89081. If you have any questions, please call our office at (702) 642-2628 or (800) 899-7690 FAX (702) 642-2570. casontravelandtours1@cox.net or www.casontravelandtours.com                                                      
                                                                             Roommate

1.Legal Name ____________________                          ____________________________
(As it appears on your picture ID)

2. Date of birth ____________________                           ___________________________

3. Street address_____________________                    ___________________________

4. City/State/Zip ______________________               ___________________________

5. Home Phone______________________                      ___________________________
Email ____________________________                       ___________________________

6. Work Phone  ________________                                  _____________________________

7. Cellular ________________                                           _________________________
8.In case of accident or emergency, person to notify at home:
Name __________________ Relationship _______________ Phone ____________ 9. Are you a ( ) Smoker ( ) Non-Smoker 10. Will you be celebrating a birthday or anniversary on this cruise? If so, list the date and occasion. ________________________
11. I would like to share a dining table with _______________________________________ (friends, family, etc.)
12. Cabin Selection: Inside 4a ___ Oceanview 6a ____ 6b ___  Demi Suite/ Balcony _____ Penthouse Suite _____
single __ double ____ triple ____ quad ____

13. I ____________________________________ hereby authorize Cason Travel & Tours to charge my credit Card #______________________ EXP _______ Back _______
14. Credit card holder name ____________________ Address __________________

15.Credit Card Holder Signature ____________________________________ Amount to charge $___________ For cruise and air payments for myself and/or_____________________________________________________ (Full name(s) of guest(s) if other than the cardholder) aboard the Carnival Elation February 22, 2009.
Booking #_________________________________ •. Third party charges – require an authorization. This is when the cardholder is not sailing, or if the cardholder is paying for a cabin other than theirs. 
16. Trip cancellation Insurance = $69 Yes_________ No___________
17. A valid passport is required for the Cruise.
18.I understand that in the event of cancellation, penalties will be assessed: $50 of deposit is non-refundable.
19. Charge my credit card every 30 days according to payment schedule: Yes ___  No ____

Chapter:          Las Vegas _________________              Phoenix ____________________

The 100 Black Men of America, Inc. is recognized as one of America's premier community service organizations. Members in the 88 chapters in the U.S. and aboard serve as beacons of leadership in their communities and create an environment where youth are motivated to achieve. www.100blackmenlasvegas.com
 You Haven't Lived Until You've Cruised!