Please note that this form will not submit and transmit to your advisor unless all fields with a * are completed or checked.

Your First and Last Name *

Who is your Diserella Travel Advisor * 🛈

Check here if you have already submitted payment information and now ONLY need to upload passports.

Please select your destination(s). Mark all that apply. *

Do you have a Cruise Group Code? Please select the code you were provided.

Tell Us About The Trip You Are Booking

From your Quote e-mail, please tell us which package (Option # or Resort Name or Cruise Line) you wish to book or place on hold.

For verification purposes, what is the total cost quoted for the package you are choosing.

Please list any Add-On's or Options you would like to include in your package.

Would you like to purchase the quoted Trip Protection? *

How many CRUISE NEXT deposits do you want to purchase? Each deposit is $200 for one cabin on one sailing. Deposits will be processed by Royal Caribbean on 6/30/23. Cruise Next deposits are non-refundable, but are transferable until you select a ship and sail date.

Terms and Conditions *

I confirm that I have read and agree to the CRUISE NEXT Terms and Conditions provided at www.diserella.com/cruise-next

Which deposit option will you be paying today?

$50 - Hold your space in the group only

$200 - Hold my space and reserve a specific cabin

Choose the option that fits your travel party:

We are paying as a couple with one payment type/card.

We are splitting the costs and each paying separately.

Which stateroom category would you like to reserve?

Do you have a Deck Number or Location preference (near elevators, mid-shift, aft, forward, port, starboard)? Please note any preferences below.

Would you like to add pre-paid gratuities to your reservation?

Yes

No

Would you like the beds in your cabin together or apart?

Together

Apart

If you or anyone in your travel party has any mobility issues, disabilities, or food allergies or preferences, please inform me below so that I may make the proper arrangements.

Traveler Information

Full legal name and dates of birth are required for ALL guests.

We cannot complete your booking without this information.

	Prefix - Mr, Mrs, Miss, Mstr, Dr, etc.	First Name	Last Name	Date of Birth
Guest 1	Prefix - Mr, Mrs, Miss, Mstr, Dr, etc.	First Name	Last Name	Date of Birth
Guest 2	Prefix - Mr, Mrs, Miss, Mstr, Dr, etc.	First Name	Last Name	Date of Birth
Guest 3	Prefix - Mr, Mrs, Miss, Mstr, Dr, etc.	First Name	Last Name	Date of Birth
Guest 4	Prefix - Mr, Mrs, Miss, Mstr, Dr, etc.	First Name	Last Name	Date of Birth
Guest 5	Prefix - Mr, Mrs, Miss, Mstr, Dr, etc.	First Name	Last Name	Date of Birth
Guest 6	Prefix - Mr, Mrs, Miss, Mstr, Dr, etc.	First Name	Last Name	Date of Birth
Guest 7	Prefix - Mr, Mrs, Miss, Mstr, Dr, etc.	First Name	Last Name	Date of Birth
Guest 8	Prefix - Mr, Mrs, Miss, Mstr, Dr, etc.	First Name	Last Name	Date of Birth
Guest 9	Prefix - Mr, Mrs, Miss, Mstr, Dr, etc.	First Name	Last Name	Date of Birth

Destination Account Information

Please provide your My Disney Experience account information below.

MDE Username or Email Address

MDE Password

I do not have a My Disney Experience account.

Do you have a Disney Visa card? (Should a future promotion become available)

Yes

No

No, but I would consider getting one.

Disney sometimes releases discounts that require a Disney+ account. Do you have a Disney+ account?

Yes

No

Disney+ email address

Passport Upload

Passport information only needs to be included if transportation requires it. Please see the list below or ask your agent if you are still unsure.

International Flights - Passport Required

International All-Inclusive Package - Passport Required

International Travel Package - Passport Required

Domestic Flights - Government Issued ID or Passport Required

Closed Loop Cruises (starts and ends at the same US port) - Government Issued ID AND

official birth certificate (do not upload birth certificate) OR a Passport (recommended)

All other cruises - Passport Required

In most cases, cruise lines, airlines, and tour operators will charge a fee for each name, birth date, or ID/Passport number that must be changed. If you submit incorrect information and a change is needed, this fee will be passed onto you.

If you arrive at the cruise port or airport, and your name or other information does not match the information on your reservation/ticket, you will be denied boarding and will potentially lose all funds paid toward your vacation.

Diserella Travel STRONGLY recommends that all cruise passengers obtain a passport before sailing. While many cruise lines allow passengers on Closed Loop cruises (departing from and returning to the same US port) to sail with just a birth certificate and photo ID, you will have to have a passport should something happen that requires you to fly back to the United States from an international cruise port.

In most cases, passports must be valid for at least 6 months past your trip return date.

Check this box if your vacation requires a passport, but you or someone in your party has not yet obtained or received your passports.

If you have not yet obtained or received passports, you must email your agent after submitting this form with the following information: 1.) each name as it will appear on the forthcoming passport(s) — usually the full legal name, 2.) each person's country of citizenship, and 3.) each person's address as it will appear on the passport if it is not the same address as provided below. Please also triple verify that the date of birth entered above for each person is 100% correct. Once you have received your passports, you will need to return to this form to upload them. Do not email images of your passport or photo ID to your agent! I understand that the information provided to my agent to book my trip (name, date of birth, country of citizenship, and date of birth) must match exactly the information on my forthcoming passport. If it does not, I may be responsible for fees associated with changing or rebooking my vacation. I also understand that if anyone in the travel party is denied a passport or does not receive a passport in time for the trip, that one or more passengers may not be able to travel and that there may be financial repercussions up to and including full loss of monies paid. *

I agree to the above.

Please upload an image of the first page of your passport or photo IDs (see information above for what is required for your type of vacation).

Your Contact Information

Your Email Address *

Your Mailing Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Planning Fee Agreements

Ticket Planning Deposit (After submitting this form, you will receive an invoice for payment of your planning fee.):

I understand that my planning deposit is non-refundable, but will be applied to my balance when tickets are purchased.

I understand that should I cancel my trip, my deposit will be retained by my Diserella Travel agent for their time spent planning my trip.

I understand that if I decide to only purchase 1- or 2- day Walt Disney World or Disneyland tickets or only single park Universal tickets, that my deposit will convert to a planning fee (not applied to my balance) since my agent will not be paid by the supplier.

Planning Fee:

I understand that my planning fee is non-refundable and is payment for my Diserella Travel agent's time and effort in planning my vacation. *After submitting this form, you will receive an invoice for payment of your planning fee.

Payment Information & Authorization

Please note that your card will not be immediately and/or directly charged upon submittal of this form. Rather your agent will use the information submitted to make your bookings and process your payments with the travel supplier(s).

For your protection, Diserella Travel Agents are only authorized to accept credit card and gift card payments. Arrangement for payment by cash or check must be made with Melanie Pendrak, owner of Diserella Travel, only.

Payment Type

Gift Card Number

PIN #

Amount to pay from this card?

Name as it appears on the card

Rewards Card Number

Amount to pay from this card?

Is your billing address the same as your mailing address?

Yes

No

Billing Street Address

Billing City

Billing State

Billing Zip Code

Card Type

Credit Card Number

Expiration Date (mm/yy)

CVC/Security Code

Amount to charge to your credit card/debit card today?

Check to agree: *

I understand that multiple payments may be needed to complete the full balance due, and that my information will be saved on file for future approved transactions made on my behalf.

I have reviewed, understand and agree to all potential Cancellation, Refund, and Surcharge Policies and Fees by the suppliers within my reservation.

Check to agree: *

I have reviewed, understand and agree to all potential Cancellation, Refund, and Surcharge Policies and Fees by the suppliers within my reservation.

By signing below I authorize Diserella Travel to process the above payment.
Signature *

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By signing below I authorize Diserella Travel to use the information provided herein to complete travel booking on my behalf.
Signature *

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Today's Date * +

Covid-19 Waiver

As the worldwide COVID-19 corona-virus pandemic remains ongoing at this time, I acknowledge that for this reason, and other reasons not reasonably foreseeable at this time, these travel plans may be interrupted or canceled by the supplier that is providing them, a government entity or other third party over which Diserella Travel has no control. I further acknowledge that the supplier's own cancellation, re-booking and refund policies, subject to any applicable law that is now or may later be in effect, will govern my rights and remedies, including my right to receive a refund, in such an event. Moreover, I understand that should I elect to purchase travel insurance, the terms of the policy will dictate whether, and to what extent, coverage for any financial loss may exist under the circumstances. By signing below, I hereby agree to hold Diserella Travel harmless and release the agency from any and all liability for any damages, including but not limited to monetary losses, I may incur as a result of such interruption or cancellation of these travel plans.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 while traveling. Such exposure or infection may result in personal injury, illness, permanent disability, and possible death. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with Diserella Travel.

As travel opens around the world, all destinations, airports, air carriers, hotels, restaurants, transfer companies, car rental companies, shops and excursions have established COVID-19 safety measures and precautions which may change from day to day. These safety measures may include, but are not limited to: curfews, attraction closings and reduced hours, size of group gatherings, social distancing requirements, health screenings, self-quarantine requirements and COVID test results. By signing this agreement, I accept ultimate responsibility for myself and my traveling party to have all the necessary provisions for travel (such as COVID test results, pre-travel questionnaires, etc.) Moreover, I understand that I should assume responsibility for the necessary documents (such as COVID test results, pre-travel questionnaires, etc.) considering COVID-19, in order to travel to my specific destination.

By signing below, I agree to the Covid-19 Waiver *

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Diserella Travel Terms and Conditions

AGENCY –
Diserella Travel is acting as an agent for its suppliers and is not the direct source or supplier of the travel services requested. By approving use of these suppliers, the traveler agrees not to hold Diserella Travel or its Travel Advisors responsible should any of these suppliers: 1) fail to provide the travel services purchased; 2) fail to comply with any applicable law; or 3) engage in any negligent act or omission causing injury, damage, delay or inconvenience.

Diserella Travel is not responsible for, nor can it be held liable for, any injury, damage or loss suffered because of any conditions, actions or omissions that are beyond its reasonable control.

Travel to many parts of the world may involve exposure to a variety of health and/or safety hazards, including but not limited to disease, crime, terrorism and warfare. Diserella Travel is not responsible for advising travelers of whether they should travel to any particular place at any particular time. It is the traveler’s responsibility to stay informed by referring to objective third-party sources of travel information, such as that maintained by the U.S. Department of State (travel.state.gov).

PROOF OF IDENTITY & LEGAL ABILITY TO TRAVEL –
The Transportation Security Administration (TSA) requires passengers to carry a government issued identification (ID) card in order to board a flight. The name, date of birth and gender that appears on the traveler’s ID card must exactly match the same such information that is listed on the airline ticket and in the booking records.

International travel requires travelers to have a valid US Passport book and may also require one or more Visas, depending upon the traveler’s destination and nationality.

Travelers under the age of 18 not traveling with both parents may need additional special or legal documentation to travel.

U.S. laws prohibit individuals with certain criminal charges, convictions, warrants, unpaid taxes, or unpaid child support from leaving the country. Travelers can be arrested before or after a flight or cruise. It is your responsibility to verify you are legally allowed to travel outside of the United States and that you are legally allowed to enter the countries or cities to which you will be traveling. Please note that individuals with a DUI charge or conviction will not be allowed to enter Canada and some other countries at all or without special permission.

It is the traveler’s responsibility to be aware of, obtain, and provide the proper documentation required for their trip. Failure to strictly comply with these requirements may result in denied boarding, undue delays, and/or fees resulting in additional cost to the traveler(s). Diserella Travel is not responsible for these fees and no refunds will be made.

Passport and visa information may be obtained by contacting the U.S. State Travel Advisory Department at (202) 647-5225 or by visiting the State Department's Web site at travel.state.gov. Non-U.S. passport holders should contact the embassies of their destination and transit countries to obtain entrance requirements. To obtain medical information, please contact the Centers for Disease Control at (404)332-4559 or visit the CDC's website at www.cdc.gov.

RATES & INCREASES –
All quoted rates are subject to change without notice until initial deposit or payment has been made. Discounted fares typically involve restrictions and changing any aspects of travel arrangements may result in additional payment due.

Airline tickets, air tours and/or other products may be subject to supplemental price increases after the date of purchase due to additional costs imposed by a supplier or government agency. This may include, but is not limited to, increased fees, fuel surcharges, taxes, fluctuations in foreign exchange markets or any combination thereof.

Diserella Travel strongly advises travelers to use a credit card as this may offer a better opportunity to dispute the charge should a vendor cease operating.

Refunds from a supplier may take 6-8 weeks to process.

TRAVEL INSURANCE –
Diserella Travel strongly recommends travel insurance be purchased for all travelers at the time of initial deposit to cover risks inherent in travel. Diserella Travel Advisors are not insurance experts and cannot guarantee the adequacy or extent of an insurance policy. Travelers are advised to read and become acquainted with policy documents and contact the insurer for clarification or concerns.

I agree to the Diserella Travel Terms and Conditions *

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Please note that, after clicking the Submit button below, you may not see the Success Message unless you scroll back to the top of the screen or if pop-up's are blocked on your computer or device. If you are unsure if your form was submitted, please contact your agent. Thank you!