My Emerald Holiday

Please tell us more about yourself(ves). Thank you—

My Name:
My Email Address:
Note: We need your Email address in order that we can contact you.

1 The Exact Names of All Members in My Party (Travel Ids)—Please include Ages.
Depending on airline/destination, an "Age" Discount may be available:

2a My (Our) Phone #:
2b My (Our) Fax #:

3a My (Our) Address:
3b My (Our) City:
3c My (Our) State:
3d My (Our) Zip Code:

4a Departing From:
4b Going To:
4c Returning From:
4d Final Return Destination:

Credit Card Information—
Please note your credit card will not be charged without your Signed Authorization—

AMEX Visa MC Discover

Credit Card #:
Exp:
Name on Card:

Preferred Emerald Holiday—
Preferred Emerald Holiday Package
5a My (Our) Preferred Emerald Holiday Package—1^st Choice:
5b My (Our) Preferred Emerald Holiday Package—2^nd Choice:
Preferred Emerald Castle, Manor House or Hotel
5c My (Our) Preferred Emerald Castle,
Manor House or Hotel—1^st Choice:
5d My (Our) Preferred Emerald Castle,
Manor House or Hotel—2^nd Choice:

6a My (Our) Departure Date:
6b My (Our) Return Date:

7 My (Our) Frequent Flyer Numbers:

8 Additional Information or Requirements: