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Itinerary: _____________________________
Departure Date: ________________________
Departure City: ________________________
Are you extending your trip? Y/N
If so, please complete:
Return Date: __________________________
Return City: ___________________________
Address: _____________________________
City, State, Zip: ________________________
Date(s) of Birth: ________________________
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Telephone:
Home:_______________
Work:_______________
I will be sharing a room with:_______________
_____________________________________
____I am registering with a single suppliment.
____Please assign me to a:
[] smoking []non-smoking room.
____I am enclosing $200 deposit per person.
____I am registering for a full payment of $________.
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