Passenger Pre-registration Information: Dear Guest: If you have not already done so, please provide the following information so that I may complete the required pre-registration form for you cruise. You may fax the completed form to my office at 781-353-3930, phone it in to 781-740-0458 ext 2 or email it back to borntotravel@comcast.net. LIST NAME EXACTLY AS IT APPEARS ON YOUR PASSPORT OR DRIVER”S LICENSE. First Name: ______________________________ Middle Name: _______________ Last Name: ______________________________ Home Address and Zip Code: ______________________________ Home Telephone ______________________________ Work Phone: ______________________________ Email Address: __________________ Name and phone of Emergency Contact: ___________________________ Your Date of Birth: ______________________________ Place of Birth: City,State,Country ______________________________ Passport Information: Name as it appears on passport ______________________________ Passport Number ______________________________ Passport Country ____________ Place of Issue ______________________________ Date of Issue ______________ Date of Expiration ________________ Past Cruiser Information: If you have traveled on this cruise line in the past, please list your past passenger program number: ______________________________ DO YOU HAVE ANY SPECIAL MOBILITY OR DIETARY NEEDS? ________ Please Describe: