Due to TSA regulations, the name on your airline tickets MUST EXACTLY MATCH the name on your passport or photo identification. Should you wish to provide us with copies of your passport or photo identification, please scan them and attach them below.
General Participant Information
Please mail all correspondence to our: Home Address Business Address
Note: All correspondance will be mailed to your home address, unless otherwise requested.
Primary E-Mail Address: *
Choose Your Program (check all that apply)
Puerto Vallarta, 2012
One (1) couple, double occupancy at 22,700 points per couple One (1) passenger, single occupancy at 16,000 points per person One (1) additional passenger, triple occupancy, as adult (18 yrs and older), at 9,900 points additional One (1) additional passenger, triple occupancy, as child (under 18 yrs old), at 6,200 points additional Two (2) additional passengers, quad occupancy, as adults (18 yrs and older), at 19,800 points additional Two (2) additional passengers, quad occupancy, as children (under 18 yrs old), at 12,400 points additional Two (2) additional passengers, quad occupancy, one adult and one child, at 16,100 points additional
Note: The travel dates for the Puerto Vallarta trip are Thursday, February 23 through Tuesday, February 28, 2012. The maximum number of passengers who may occupy a room is four.
London & Paris, 2012
One (1) couple, double occupancy at 39,600 points per couple One (1) passenger, single occupancy at 26,400 points per person One (1) additional passenger, triple occupancy, as adult (17 yrs and older), at 14,400 points additional One (1) additional passenger, triple occupancy, as child (under 17 yrs old), at 12,400 points additional Two (2) additional passengers, quad occupancy, as adults (17 yrs and older), at 28,800 points additional Two (2) additional passengers, quad occupancy, as children (under 17 yrs old), at 24,800 points additional Two (2) additional passengers, quad occupancy, one adult and one child, at 28,800 points additional
Note: The travel dates for the London & Paris trip are Friday, October 5 through Saturday, October 13, 2012. The maximum number of passengers who may occupy a room is four.
Departure Information
Requested Departure City: Please select...
Cincinnati (CVG)
Cleveland (CLE)
Columbus (CMH)
Detroit (DTW)
Grand Rapids (GRR)
Indianapolis (IND)
Louisville (SDF)
Other
Departure City (be specific):
By choosing a departure city othe than those listed above, you acknowledge that there may be additional fees not otherwise included in the cost of your trip. If your choice may incur a surchage, you will be contacted within 48 hours for authorization.
Special Information (please be specific)
Terms & Agreement
We would like to pay our deposit by: Check Bill our CDC account
Check Number:
If paying by check, please send your deposit, along with a copy of this form, to: CDC Distributors, 10511 Medallion Drive, Cincinnati, OH 45241, Attention: Sue Bertholf.
By clicking on the "Submit" button, I acknowledge that I am enrolling in a travel program offered through CDC Distributors and authorize the special add-on pricing chosen above.
Furthermore, I have read the program rules and agree with the terms and conditions as set forth by CDC Distributors, Inc. and understand that should I drop from the program, I will be responsible for any cancellation penalties incurred on my behalf.
Point quotas in this agreement are based on rates, tariffs and currency exchange in effect as of May 1, 2011. CDC Distributors, Inc. reserves the right to increase your point quota in the event said rates, tariffs, and/or currency exchange rates increase at any time from enrollment to trip operation.
Items marked with an (*) are required.
