Please print the application and fill it out. After you have completed the application,
mail it along with with your $100 deposit to:

University Beach Club
600 W. 28th Street, Suite #102
Austin, Texas 78705

You can also fax the application to (512) 469-0399
If you are unable to print the application, e-mail us and we'll mail you one.

Legal Last Name: _______________________________________

Legal First Name: _______________________________________

Male Female

Current Phone: (____)___________________

Home Phone: (____)___________________

Current Mailing Address: _______________________________________

Apt./Room#: ________

City: _________________________________ State: ________ Zip Code: _________

University: ______________________________

Credit Billing Address: __________________________________________

City: _________________________________ State: ________ Zip Code: _________

Date of Birth: _______ /_______ / _______

Roommates: 1. ______________ 2. _____________ 3. _____________ 4. ______________

Group Name (if applicable):_______________

Trip Code: First Choice: _______________ Second Choice: _______________

Acapulco Hotel: (Please Check One)
First Choice:
Continental Emporio/All-Inclusive Continental Emporio
Casa Inn
Second Choice:
Continental Emporio/All-Inclusive Continental Emporio
Casa Inn

Puerta Vallarta Hotel: (Please Check One)
Canto Del Sol

Eastern Cruise : (Please Check One)
First Choice:
Inside Cabin
Outside Cabin
Veranda Cabin
Panorama Cabin
Second Choice:
Inside Cabin
Outside Cabin
Veranda Cabin
Panorama Cabin

Western Cruise : (Please Check One)
First Choice:
Inside Cabin
Outside Cabin
Veranda Cabin
Panorama Cabin
Second Choice:
Inside Cabin
Outside Cabin
Veranda Cabin
Panorama Cabin

We will make every effort to give you your first hotel/cabin choice, but due to the great demand and
overbooking of Spring Breaks hotel rooms, we may substitute your hotel.

Number of roommates: 4 per room 3 per room 2 per room

Deposit: (Please Check One) Check MC Visa Amex Discover

$100 Deposit per person (Non-refundable, but counts toward balance.)

Credit Card Number: ___________________________ Expires: _______

Card Holder's Name: _____________________________________

I have read the Terms and Conditions and I fully understand them. Final payment is due on February 4, 2006.

Signature: x_____________________________________ Date: _______________

Make Checks Payable to University Beach Club.

Sales Rep: _______________

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