Please print the following form, fill in as much information as possible, and mail or fax to: PIED PIPER TRAVEL 330 West 42nd. Street - Suite 1804 New York, NY 10036 Fax: (212) 239-2275.

RESERVATION FORM - SAILINGS OF PIED PIPER's GROUPS ON THE QUEEN VICTORIA.

1. PASSENGER INFORMATION 

Reservation number for existing reservations: ____________________________

Passenger's Name_________________________________________________________________

Traveling with______________________________________________________________________

(If you would like us to arrange a share, please state on above line. Please indicate if you are a smoker. PLEASE NOTE THAT ALL PAYMENTS MADE FOR SHARE RESERVATIONS ARE NON-REFUNDABLE UNLESS A SHARE REPLACEMENT CAN BE FOUND)

Address of first passenger____________________________________________________________

City ________________________________________________ State _______ Zip Code _________

Telephone (Home) _______________________ (Business) _________________________________

Address of second passenger_________________________________________________________

City ________________________________________________ State _______ Zip Code _________

Telephone (Home) _______________________ (Business) _________________________________

Please provide your email address: __________________________________________

2. CRUISE INFORMATION I would like to sail on the ___________ cruise, sailing on ____, ______.

3. CABIN REQUEST (PLEASE INDICATE FIRST AND SECOND CHOICES.)

_____ I would like an inside double cabin, Category ____, at $_______ per person, double occupancy.

_____ I would like an outside double cabin, Category ____, at $______ per person, double occupancy.

_____ I would like a single inside cabin, Category ____, at $_______ total for the cabin.

_____ I would like a single outside cabin, Category ____, at $_______ total for the cabin.

_____ Please arrange a share (if available) in Category ____, at $_______, double occupancy rate.

(Taxes and gratuities are additional.)

4. PAYMENT INFORMATION

_____ American Express _____ Visa _____ Mastercard _____ Discover

Card Number: ____________/_____________/____________/____________

Expiration Date: MO/YR _____/_____ Security Code: ___________

Card Holder's Name ______________________________________

Billing Address ____________________________________________

City _________________ State ______ Zip ________

I authorize Cunard to charge deposits and payments to my credit card in accordance with the payment schedule.

Card Holder's Signature _______________________________________________

Date __________________________________________

5. PAYMENT/CANCELLATION FEES SCHEDULE

Deposit Due at time of booking (Cancellation Fee $75) / 10% Cancellation fee applies 120 days prior to sailing / Final Payment Due 90 days prior to sailing (Cancellation Fee 50%) / No Refunds 30 days prior to sailing.

6. TRAVEL AGENT'S INFORMATION

Travel Agent, please place

your stamp here, to the right. ==================>

7. AIR INFORMATION I would like to purchase CUNARD's air add-on for one-way/roundtrip travel to _________ from _____________________ at $ ______ extra per person. This will be paid on the final payment date as per the payment information supplied.

8. INSURANCE REQUEST

Would you like to purchase the optional CunardCare travel insurance of $______ (6.99% of the total fare) per person? ____________ Yes ____________ No (Please initial)

9. DINING REQUEST

I would like to request the following, subject to availability: Early or Late (Britannia passengers) _______ Table size (Small or Large) _________  (Late dining recommended, larger tables are with other group members.)

10. OTHER INFORMATION AND CONDITIONS

Liability and Responsibility - Please read the following carefully. Making a reservation and acceptance of tickets and/or vouchers shall be deemed to be an acceptance of these conditions. PIED PIPER TRAVEL, the tour operator, acts solely as an agent for the passenger. PIED PIPER TRAVEL and CUNARD does not accept responsibility in whole or part for any delay, loss, accidents, personal injury, sickness, medical expenses, or property damage occasioned by fault or negligence of any person, employee or company entrusted with the performance of such service from whatever cause. The tour operator and cruise line will not be responsible for any expense or inconvenience caused by late arrivals and departures of trains, ships, airplanes, buses, autos or any changes of schedule beyond its control. The tour operator and cruise line will not accept responsibility for the loss of, or damage to your luggage, money, jewelry, valuables or any other belongings whatsoever and howsoever caused.

The tour operator is responsible for all services to be provided in respect to this tour. All tour services, including but not limited to hotel accommodations, restaurants, guide services, ground transportation, and cruise transportations, are furnished by contractors that are independent from, and that do not act for or on behalf of or as agents of or as joint ventures with the air carrier, cruise line or tour operator.

The right is reserved by the tour operator to make any changes that might become necessary with or without notice. The tour operator reserves the right to accept or decline any person as a member of the tour at any time and to cancel the tour if minimum space requirements are not met. The passenger agrees to the use of his/her likeness in photo or video, unless specifically specified otherwise in writing.

The sole and exclusive responsibility of the air carrier and cruise lines shall be in accordance with and as limited by the contract of carriage set forth in the passenger's ticket, baggage check and tariffs issued by the carrier/cruise line. The cruise line ticket and contract will be included in passenger documents. The passenger ticket, when used, shall constitute a sole contract between the airlines/cruise lines and the purchaser of these tickets and/or passenger. These carriers and other carriers are not responsible for any act, omission or event during the time the passengers are not on board their planes or conveyances.

Deposit/Cancellation Policy Per Person - Any changes in passenger name will be considered a cancellation. All deposits, payments, and cancellation fees are per person. The purchase of trip cancellation insurance to protect the passenger is strongly recommended and can be arranged by your travel agent.

Signature/Authorization - to be signed by each passenger.

I have read and agree to the terms, liability, responsibility, payments schedules, deposit policy, and cancellation policy as written above. I have been offered travel cancellation insurance.

Passenger's Signature ____________________________ Date ________

Second Passenger _______________________________ Date _________