Traveler Information Travel Request Form Please complete the following form to help me better serve you and your travel needs. Full Name* First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email* example@example.comPreferred Phone Number*Contact Preferences - check all that apply* Yes, it's ok to text me Yes, it's ok to call me Yes, it's ok to leave a message Total number of guests OVER the age of 12 travelingAnyone who will be 12 by the end of the tripTotal number of guests UNDER the age of 12 travelingPreferred Destination***Please note that certain personal legal issues can prohibit you from obtaining a passport and some countries will deny entry for past/current legal issues even if you hold a current passport. If you or someone in your group may have issues please let me know during our phone consultation or just type PASSPORT ISSUES in the above box so we can plan a vacation that everyone enjoys.Untitled* Mobility issues need to be considered Special dietary requirements need to be considered Someone in the group is Active Military, Retired Military, Fire, EMS or Police Someone in the group is pregnant There are no special circumstances to consider Start Date for Travel* Date Format: MM slash DD slash YYYY DateEnd Date for Travel* Date Format: MM slash DD slash YYYY DateTotal vacation budget for your entire group* $3,000 - $5,000 (1,500-$2,500 per person) $5,000 - $8,000 $10,000 - $15,000 $15,000 - $20,000 Over $20,000 Other - please specify in the additional requests below My/Our Travel Experience*Very little, stay close to homeNever left the lower 48 statesVisited Mexico, Caribbean, Hawaii and/or CanadaTraveled to other continentsPreferred Aiport*Airport of originActivities we enjoy while traveling* Sailing, boating, yachting Sightseeing, walking tours Spa treatments Yoga Running, biking, etc Hiking, kayaking, experiencing nature Scuba diving Snorkeling Experiencing local culture and cuisine Golf Fishing/hunting Shopping Relaxing poolside or at the beach Wine tasting, culinary classes Fine dining/good wine Adventure activities: Ziplining, rafting, etc Passports?* We all have valid passports that will expire more than 6 months after the final date of travel Some have valid passports that will expire more than 6 months after final date of travel No one has a passport yet I have no idea We don't need a passport for our trip Explain in detail any additional requests/concerns you would like me to take into consideration when researching options.Passenger Information:This information below is now required to generate accurate quotes from most suppliers. I must have complete information for all travelers in your group. Passenger #1* First Middle Last Name as shown on passport (or ID if there is no passport):Date of birth* Date Format: MM slash DD slash YYYY Passenger #2 First Middle Last Name as shown on passport:Date of birth Date Format: MM slash DD slash YYYY Passenger #3 First Middle Last Name as shown on passport:Date of birth Date Format: MM slash DD slash YYYY Passenger #4 First Middle Last Name as shown on passport:Date of birth Date Format: MM slash DD slash YYYY Captcha
