Name
Address
City:

State Zip Code
Country if other than U.S.

E-mail
Tel
FAX

 

Expected Date of Travel:

Length of Stay: days

Number of Passengers:

Destination:

Type of room/bedding: Choose One Single Double Triple Quadruple

 

Have you been to any of the following:

In the United States:

South	Mid-west	West Coast
New England	North West	Hawaii and/or Alaska

Outside the United States:

Caribbean	Europe	Asia
South America	Canada	Central America
South Pacific	Orient

Do you need a rental car? Yes No

If yes: Choose One Compact Mid-size Full Luxury Convertable

Do you need hotel accomodations? Yes No

Do you need airline reservations? Yes No

If yes: Airline preference

Frequent Flier #'s

What is the budget that you have in mind for this trip? $

Style of hotel you like to use: Choose One All-inclusive Resort Hotel Luxury Hotel Resort Hotel Bed and Breakfast Motel Guest House
(if you would like to select more than one area, then hold down the control button on your keyboard while you click the selections you want)

Do you want your hotel to be:

Exclusively Gay

Male

Female

Both

Gay Friendly

Not Important

What are your interests for the vacation:

Water Sports	Beach	Shopping
Night Life	Bicycling	Tourist Attractions
Hiking	Fine Dining	Just Relaxation

Please contact me as soon as possible regarding this matter.

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