Cruise with the Blues
2025 Registration Form
First Passenger - Full Legal Name
*
First Name
Middle Name
Last Name
Nickname for Name Badge:
Date of Birth:
*
-
Month
-
Day
Year
Citizenship:
*
U.S.
Other
If Other, please specify:
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
*
Please enter a valid phone number.
Email:
*
example@example.com
Add another person?
Yes
No
Second Passenger - Full Legal Name
First Name
Last Name
Nickname for Name Badge:
Date of Birth:
-
Month
-
Day
Year
Citizenship:
U.S.
Other
If Other, please specify:
Cabin Category:
First Choice:
1.
Second Choice:
2.
*
Personal/Medical Information:
Please Specify Passenger
Special Dietary Requests:
Accessibility Needs:
Payment:
PLEASE CALL TO COMPLETE YOUR CREDIT CARD PAYMENT - 314-968-9600
Payment option:
*
Pay by check - mail to Altair Travel & Cruises ATTN: Sherry Norris 2025 S Brentwood Blvd Ste 100 Brentwood MO 63144
Pay by credit card - please fill out below information, then CALL TO COMPLETE CREDIT CARD PAYMENT - 314-968-9600
Altair Travel is authorized to charge my credit card for deposit:
Charge Amount
Last 4 digits of card:
Signature
*
Name
*
First Name
Last Name
Submit
Should be Empty: