Register Now! Your Full Name (exactly as it appears on your passport)*(You will need a passport for #IndieCruise 2020. If you don't have a passport at this time, for purposes of this form, use the name you plan to use to get your passport. Your passport needs to match the documentation we have in your registration here. Leave "Middle" blank if you do not use a middle name or initial.) First Middle Last Your Date of Birth* MM slash DD slash YYYY Your Email Address* Your Mobile Phone Number*Your Other Phone NumberThis can be home or office.Name of Emergency Contact*(Who should we call in the event of an emergency?) First Last Emergency Contact Number*Your Street Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country What is the name of your business? If you do not have a business, say that.* What is your website URL? If you do not have a website, include any public social media outlet you use.* What is your Instagram handle?*If you do not have an Instagram account please provide a different social media account handle. If you have any special needs or health-related requests, share them with us in the space provided and we will do our best to accommodate you:Which room category do you plan to reserve?*Until your deposit and first payment are received, prices are subject to change based on availability.OCEAN VIEW JUNIOR SUITE (single occupancy)OCEAN VIEW JUNIOR SUITE (double occupancy)OCEAN VIEW JUNIOR SUITE (double occupancy + 1 child)PARTIAL OCEAN VIEW JUNIOR SUITE (single occupancy)PARTIAL OCEAN VIEW JUNIOR SUITE (double occupancy)PARTIAL OCEAN VIEW JUNIOR SUITE (double occupancy + 1 child)Do you plan to reserve your room for any days before or after Indie Cruise (before January 13 or after January 17)?*yesnoIf you clicked "yes" to the above, please list the exact dates you are requesting in the space below.Would you like information about purchasing tickets to IBN's 20th ANNIVERSARY CELEBRATION PARTY?*You will receive an separate email with all the party details. yes no If you have a roommate, please type his or her name here First Last If you have a second roommate, please type his or her name here First Last Would you like for us to help you find a roommate?* yes no Are you interested in a quote for travel insurance?* yes no Are you a smoker?* yes no (All rooms are non-smoking. There are smoking areas throughout the resort. If you are a smoker, and you need a roommate, we will try to help you connect you with another smoker so you can be more comfortable throughout your retreat. For your comfort and consideration, we will not pair smokers with non-smokers without prior written agreement of both parties.)Click the YES button to acknowledge your understanding of payment obligations!* Yes, I understand that my registration is not complete until I email the completed and signed authorization form to suzanne@tcava.com Click the "YES" button above to confirm your understanding that your registration for Indie Cruise 2020 is not complete until you have faxed the completed and signed payment authorization form to the travel agency as indicated on the next page that will appear after you click the Submit button below. Your are NOT registered for Indie Cruise 2020 until you fax the signed payment authorization form to the number on the next page.Please click the "Yes, I agree" button acknowledging consent to storing and using your personal information to reserve your spot on Indie Cruise and get in touch with you.* Yes, I agree The Indie Business Network will send or share the data on this form with The Cruise and Vacation Authority and their vendors. TweetSharePin