Confidential Profile Leisure Consulation FormFull Name* First Last Primary Phone*Alternate PhoneAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Referral SourceGeneral1. Do you have something in mind for your trip?2. Have you researched or booked your trip?3. Do you have a budget or are you familiar with the cost of the trip?Emotional4. What experiences would you like to enjoy on this trip? (Romance, Adventure, Excitement, Family Time, Relaxation, Education, ...)5. What is your idea of (romance, relaxation, adventure, ...)?6. Is this trip for a special occasion or just a getaway?Lifestyle7. Would you prefer an upscale experience or is budget a deciding factor?8. What would you consider a value, moderate or upscale experience to include?9. Do you prefer a well-known and popular or more exclusive experience?Social10. Do you like the excitement of crowds or a private and quiet location?11. Some places/ships are more family oriented. Is this an important factor for your trip?12. Do you like to explore on your own, or do you prefer guided tours, or both?Dining13. What are your food and dining preferences?14. Do you have a specific preference (buffets or full service) or special dietary need (Kosher, vegan, etc.)?Activities15. What activities do you hope to experience on your vacation?16. Are nightlife activities (clubs, dancing, casinos) of interest? Do you prefer activities to be available on site?17. Do you like hiking, biking, horseback riding or other activities?Culture18. Do you like to explore the local culture or prefer to stay in the resort?19. Are you comfortable visiting locations where different languages are spoken? Would the language barrier be a concern?20. Would you like to enjoy familiar shops and restaurants or experience new and unique locations?Budget*Moderate (up to $1,500 per person)Premium ($1,500 to $3,000 per person)Deluxe ($3,000 to $5, 000 per person)Luxury ($5,000+ per person)Not SureOther NotesTravel Agent Name*Select Your Travel Agent. . .No PreferenceAlissa RiebMichelle SpanosSara CollierPhoneThis field is for validation purposes and should be left unchanged.