AKAversary Celebration
To reserve your space please complete the form below
Legal Name
*
Mr.
Ms.
Mrs.
Prefix
First Name
Last Name
Preferred Name
Date of Birth
*
Month/Date/Year
Mailing Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Cell Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Preferred Method of Contact
E-Mail
Phone
T-shirt Size
*
X-Small
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Line Name and Number
*
Travel Information
Preferred Airport
Do you have a passport expiring after April 2019?
*
Yes
No
Room Type Request
*
Double Occupancy (2 Double Beds)
Double Occupancy (King Bed)
Single Occupancy
Triple Occupancy
Do you have a roommate request?
*
Yes
No
If yes, please list the name(s)
Would you like travel insurance?
*
Yes
No
Payment Option
*
Pay in Full
Payment Plan
How would you like to pay your deposit?
*
PayPal
Debit/Credit Card
I acknowledge that I have read this registration form completely and the information I provided is accurate. I understand that all payments are non-refundable and must be paid by the deadline.
Do you agree to the terms and conditions
*
Yes
No
Submit
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