Reggie's 50th Birthday Trip
Name of 1st Guest
*
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Name of 2nd Guest
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Check-in Date
*
-
Month
-
Day
Year
What date are you checking in?
Check-out Date
*
-
Month
-
Day
Year
What date are you checking out?
Number of Guests
*
Room Type
Please Select
Select Your Room
Mirage Club 1-Bedroom Suite w/ Jacuzzi
Mirage Club Sky Suite Suite w. Roof Top Jacuzzi
(great for star gazers!)
Mirage Club Swim Suite Up w/ Jacuzzi
Mirage Club Ocean View with Outdoor Jacuzzi
Calculation
Calculation
What city will you be flying from?
What city will you return to?
Please leave blank if you are returning to your departure city.
Special Requests
Submit
Back
Next
Should be Empty:
prev
next
( X )