The entire form must be completed (IN BLACK INK) and returned to secure your selected departure date.

Today's Date:____________

1^st Name:	____________________________	Gender:____	Citizenship:___________	D.O.B.	__________
2^nd Name:	___________________________	Gender:____	Citizenship:___________	D.O.B.	__________

Mailing Address:

______________________________________________________________________

City:

______________________

State:

______________________

Zip:

_____________

Day Phone:	__________________________	Evening Phone:	_________________________
Fax:	__________________________	* Email:	_________________________

Companions sharing the same room [additional charges required - max 4 guests per room]

3^rd Name:	____________________________	Gender:____	Citizenship:_______________	D.O.B.	__________
4^th Name:	____________________________	Gender:____	Citizenship:_______________	D.O.B.	__________

Please allow 15 days between travel dates. Please give at least a 45 day advance notice. Dates requested less than thirty (30) days are subject to $25.00 surcharge.

1^st Sail Date:

_____________________________

2^nd Sail Date:

_____________________________

We have enclosed $ 478.00 per couple; this is the balance due on a total of $ 478.00 per couple (U.S. funds). Make personal check, cashiers check or money order payable to ASI Travel Direct; or please charge our card below for the amount indicated. We have read and agree to all the Terms and Conditions of this travel voucher.

I/We have read and agree to the terms and conditions of this offer.

Signature:

_________________________________________________

Date:

_______________

This form will be returned to you and reservations will not be processed if it is not signed and dated.

Credit Card Type:

VISA:_____

MasterCard:_____

American Express:_____

Discover:____

Name as appears on card:

_____________________________

Total charge amount:

$___________

Card Number:

_______________________________________

Expiration Date:

_____________

Fax or Mail to:

ASI Travel Direct, 3 Sunshine Blvd , Ormond Beach , FL 32174
Fax 386-673-6005 Customer Service 800-881-9880

Your Organization:_________________________________

Expiration Date - 12-15-09

Please list couples you will be traveling with:	_______________________________________________
	_______________________________________________
	_______________________________________________

Please check any Options you would like additional Information on:

__ Extra Nights at the Island Palm

*Your Email address is very important. We will periodically Email vacation specials which will not be offered to the general public.

__ Luxury Condominium Properties

__ Island Meal Plans

__ Pre/Post Cruise Accommodations