enrollment form

SKI TRIP ENROLLMENT APPLICATION-HIGGINS

name:

companion name(s):

check here if you will book your own airfare [if you checked this box, leave the next few lines blank and go directly to address line]

departure Airport: - only if you need airfare

If we are issuing your airline tickets , we need your date of birth:

name: DOB:

nam(for airline ticketing purposes, all names must match ID presented at airport) please ensure that all names are spelled correctly on this form!!

address:city:state:zipcode

Email addresshomephoneworkphone

trip location & date: BIG SKY- (FEB.1-8)

property: HUNTLEY LODGE

accommodation type: HOTEL ROOM

price: $1630 (based on HOTEL ROOM SINGLE OCCUPANCY)

price includes: ground transfers to and from BZN Airport, 1BD SUITE - SHOSHONE for 7 nights, all taxes

Airfare additional- approximately $400 additional per person out of FLL to BZN

F9 383Q 01FEB FLLDEN SS1 728A 1000A * WE E
F9 999Q 01FEB DENBZN SS1 110P 309P * WE E
OPERATED BY REPUBLIC AIRLINES AS FRONTIER EXPR
F9 998Q 08FEB BZNDEN SS1 339P 529P * WE E
OPERATED BY REPUBLIC AIRLINES AS FRONTIER EXPR
F9 382Q 08FEB DENFLL SS1 616P 1158P * WE E

Price subject to increase due to increase in base fare prior to booking, airline taxes , fuel surcharges or airport passenger facility charges. All rates are subject to space availability at time of purchase. Space is limited and is on a first come first serve basis.

requested roommates:if different than companion name(s)

special requests:

CREDIT CARD CHARGE AUTHORIZATION

CREDIT CARD   NAME OF CARDHOLDER

     CARD NUMBER EXPDATE

For your security, American Express and MASTERCARD/VISA have instituted additional security measures for their cards.

AMEX CID                   VISA/MC CW2

(CID)This is a four-digit number that appears on the front of your AMEX card, above your card number.
(CW2)This is a three-digit security code that appears on the back of your MC/VISA card in the signature panel, and at the end of card number.

   INITIAL I understand that the total amount is due in full and the total package price will be charged to my credit card.

payments are non-refundable.

CONFIRMATION WILL BE E-MAILED TO YOU WITHIN 15 DAYS OF RECEIPT OF THIS APPLICATION.

CANCELLATIONS MUST BE MADE IN WRITING. NO REFUNDS WILL BE GIVEN ON UNUSED PORTIONS OF YOUR PACKAGE.

TRAVEL INSURANCE IS RECOMMENDED.

INITIAL---I have read and agreed to the cancellation penalties.

     SUBMIT THIS FORM BY PRESSING THE SUBMIT BUTTON.

               TO ASSURE RECEIPT, YOU MAY ALSO FAX THIS FORM TO

(954) 252-3936