UMKC
School of Dentistry

10 Day Mediterranean Cruise
Continuing Dental Education
Holland America Line
NOORDAM
September 4, 2008

Welcome to our "on-line" booking form. Please complete ALL fields, including your email address. When you have completed the form click the send button and we will process the reservation and send a tenative confirmation, pending receipt of deposit, to the email address you specify. You will have 7 days from receipt of the confirmation in which to provide your deposit, which can be with a major credit card called into our office or check sent by mail. NOTE: We cannot actually guarantee cabin assignment without receipt of deposit.
*We will not give your email address to anyone!

  Names must appear exactly as shown on your passport (required).
First name:
Last name:
Address
City
State / Provence
Zip / Postal Code
Home phone:   
Office phone:   
E-Mail:
2nd Passenger sharing cabin
First / Last Name
3rd Passenger sharing cabin
First / Last Name
4rd Passenger sharing cabin
First / Last Name
   
 
Transportation (includes ship transfers): Add round trip air from MCI $1959 pp:
I will arrange my own transportation.
NOTE: Rome airport-ship transfers can be arranged through us on the day of embarkation/debarkation even if you book your own airline flights. We will need to know the airline/flight number/times in order to make the arrangements.

           
Cabin Category requested:
Superior Verandah Suite
Verandah Stateroom
Outside Stateroom
Inside Stateroom
 
 

Date of Birth / Citizenship Following information required in accordance with the Advance Passenger Information System (APIS) under the Border Security Act:
Passenger 1 Date of Birth Nationality:
Passenger 2 Date of Birth Nationality:
Passenger 3 Date of Birth Nationality:
Passenger 4 Date of Birth Nationality:

   
   
CDE Seminar Registration:: Passenger 1: DR   STAFF
Passenger 2: DR   STAFF
Passenger 3: DR   STAFF
Passenger 4: DR   STAFF
 
Dining: 1st (6:30 pm)
2nd (8:45 pm)
 
Remarks: Please indicate any special needs or requests.

Note:

Passport not expiring within 6 months of ship's return is required. A $350 deposit per person is required to secure your reservation. Information on providing your deposit will be emailed to you. Your deposit is fully refundable until June 6, 2008, at which time your final payment will be due. Should you need to cancel after the final payment deadline, Holland America Line will assess cancellation penalties. We therefore highly recommend purchasing "trip protection insurance". Information on a protection plan will be mailed to you upon receipt of this booking form. Or, visit   CSA Travel Protection   for additional information on travel insurance services. Please call us at 1-800-326-0373 for any questions.


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