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: _______________

Cancun Hotel: (Please Check One)
First Choice:
Yalmakan Beach Resort/All-Inclusive Krystal Beach Resort Calinda America
Second Choice:
Yalmakan Beach Resort/All-Inclusive Krystal Beach Resort Calinda America

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

Los Cabos Hotel: (Please Check One)
First Choice:
Calinda Beach Resort/All-Inclusive Plaza Las Glorias Beach Resort
Second Choice:
Calinda Beach Resort/All-Inclusive Plaza Las Glorias Beach Resort

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

We will make every effort to give you your first hotel 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, 2004.

Signature: x_____________________________________ Date: _______________

Make Checks Payable to University Beach Club.

Sales Rep: _______________

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