Register by submitting form no later than November 13th, 2015

Guest

• First Name:
• Middle Name:
• Last Name:
• Date of Birth:
• Gender: Male Female

• Passport No.:
• Expiration Date:

• Nickname:

• Company Name:

AIRLINE RESERVATION REQUEST

• Once your registration form has been submitted to our office, we will book your flight and send you a copy of your itinerary for approval.
• Once your registration form has been faxed or e-mailed to our office, we will book your flight and send you a copy of your itinerary.
• Special negotiated airfare has been arranged for this program.
• Once your itinerary has been ticketed, any changes in the itinerary resulting in additional charges will be the responsibility of the qualifier/guest.

• City of Origin :DFW IAH Other

Seating Preference

• Special dietary requests:

HOTEL ROOM PREFERENCES

(Based on availability at check-in)

If you are extending your trip before or after the designated program dates, the Barceló Maya Beach Resort requires you to provide a credit card for the additional hotel room nights.

This number will be given to the hotel to secure additional room nights. You will also need to provide a credit card when you check in at the hotel.

• Credit Card No:
• Expiration Date:
• Security Code:
• Name as it appears on credit card:

I authorize additional charges associated with my hotel reservation to be billed to the credit card above.