Social Security#(USA Only)
Date of Birth
Date Of Cruise/Airline Flight.
Name Reservation is Under.
Airline(s) name and Flight #(s)
Approximate Time of Departure.
Approximate Time of Arrival.
Layover/Meet & Greet City.
Do you need to be met at the arriving/departing
ships/airports with Portable Oxygen?
If Yes, can you go as far as the baggage claim
in a wheelchair without oxygen?
Will you have any hotel stay either before
or after the cruise/flight?
If Yes please provide the hotel information below.
Will you need oxygen during your layovers(changing ships/airlines)?
If Yes please provide all ship/flight information & Itineray below.
Credit Card Information:
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