Pole Cruise USA 2018 Registration
The Ultimate Poling Adventure
www.polecruiseusa.com

Direct Deposit

Direct Deposit
Bank - Bank Of America
Account # 457037379357
Account Name - Tickled Pink Travel Inc
Routing # 122101706

Ref# First Initial Surname PCUSA18

Email address *
The First Name (as Per Passport) *
Your answer
Surname (as Per Passport) *
Your answer
Phone Number *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Address *
Your answer
Cabin Type *
Roommate/s (Full Name) *if travelling alone please put - To be paired by PCUSA *
Your answer
Bed Configuration *
Pole Studio *
Your answer
Pole Level (estimate your level for November) *
Travel Insurance Quote (recommended) *
American Citizen *
Dietary Requirements
In Case of Emergency (Name and Contact Number) *
Your answer
Payment Method *
Referred By
Your answer
Terms & Conditions *
Required
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