EmailMe Form - GROUP TRAVEL REQUEST

Name *

First Last

Email *

Phone *

### - ### - ####

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

What group trip are you interested in?
List the Trip Destination or Leader

How did you hear about this trip?

How quickly are you looking to place your deposit on this trip?

48 hours or less

7 days or less

Within the next 2 weeks

Other

Please mark any of the following statements, applicable to ANY guest in your room or traveling party. I know some questions are personal, but we need to establish if there are any Bonus offers or restrictions of travel.

	Yes	No	Other
Veteran/Active or Retired Military
Mobility or Medical Challenges
Oxygen or Other Medical Device Usage
Hearing or Sight Impaired
Special Dietary Requirements
Autism or Behavioral/Emotional Disorders
Pre-existing Medical Conditions that need insurance coverage
Pregnant or Anticipate the possibility of an established pregnancy during travel period or immediately after travel
Legal issues that may limit international travel or security checks (DUI/Child Support/etc)
International Travel with a Minor / Without Both Parents

Special notes or requests for this trip, please tell me what is IMPORTANT to you, room location requests, etc.

Anticipated Check-In/Arrival Date

MM / DD / YYYY

Anticipated Check-Out/Departure Date

MM / DD / YYYY

My intended travel companion(s) with whom I plan on sharing accomodations
(Please list names)

How many rooms do you personally need to reserve?

1

More than 1 room needed - Traveling Person will contact you for more details.

I'm not sure, I am open to an option with a roomate for this trip. Traveling Person will contact you for more details.

What kind of bedding configurations do you need?

Double beds

King bed

Triple occupancy

Other

Number of ADULTS in your room

Number of CHILDREN in your room

Child 1 - please list age at time of travel
Child 2 - please list age at time of travel
Child 3 - please list age at time of travel
Child 4 - please list age at time of travel

Will you need a Payment Plan for the balance of this trip?

If you could have a dream experience on this trip, what would it be?

What can Traveling Person do that will provide you with a huge sense of relief?

What DON'T you want?
What has gone wrong in the past that you want to avoid this time?

What is the best memory or expereince that you have from your last trip?

What big celebrations are on your horizon?

Which family/friends do you wish could come with you?

How often do you travel? Business/Leisure