REGISTRATION FORM
PKU Friends and Family Cruise
Caribbean Princess
July 31, 2004

LEGAL NAME #1:_________________________________________________

Address: __________________________________________________________

_________________________________________________________________

Phone #: (____)_______________ (home) (____)____________________ (work)

Birth Date: ________________    PKU DIET: ______ (yes) _____ (no)

LEGAL NAME #2:_________________________________________________

Address: __________________________________________________________

_________________________________________________________________

Phone #: (____)_______________ (home) (____)____________________ (work)

Birth Date: ________________    PKU DIET: ______ (yes) _____ (no)

LEGAL NAME #3:_________________________________________________

Birth Date: ________________    PKU DIET: ______ (yes) ______ (no)

LEGAL NAME #4:_________________________________________________

Birth Date: ________________    PKU DIET: ______ (yes) _____ (no)

CATEGORY CABIN: _________________ (1st choice) ___________________ (2nd choice)

Trip Cancellation Insurance Information: _____ (yes) ______ (no)

$500 PER CABIN DEPOSIT
Due by October 1, 2003
Second Deposit Due by January 31, 2004
Final Payment Due by April 15, 2004

Please send check payable to Cruisin' Inc. or fax/call me with a credit card deposit:

Cruisin' Inc.
Attention: Pat Byrne
211 W. Lancaster Avenue, Wayne, PA 19087
(610) 341-1979
Fax: (484) 367-0088