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Personal Information
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Legal Name:__________________________________
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Date Of Birth;__________________
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Legal Name:__________________________________
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Date Of Birth;__________________
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Address;____________________________________________________________________________
____________________________________________________________________________________
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Email;______________________________
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Phone:__________________
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Cell#:______________________
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Emergency Contact:____________________________________________________________________
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Cabin Selection
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Inside:_____
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Category;_______
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Price:_________
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Insurance: 100 per person:_______
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Outside;____
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Category;_______
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Price:_________
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Insurance: 100 per person:_______
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Verandah:____
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Category;_______
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Price:_________
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Insurance: 100 per person:_______
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Please initial below regarding insurance
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I would like to purchase cancellation insurance. Insurance is payable with deposit:______
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I would like to decline insurance and understand that full cancellation penalties apply:_____
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Deposit Payment Information
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I will be making my deposit by check in the amount of $250 per person:____
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Make checks pay-able to:
Mailing Address:
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KHM Travel san Diego
864 Grand Avenue #408
San Diego, Ca 92109
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I will be making my deposit by credit card in the amount of $250 per person.
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Account number:___________________________________
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Expire Date:_______________
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Security code;_______
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Charge final payment to this card? Yes__ No__
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Signature:________________________________
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