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CLIENT PROFILE
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Indicates required field
Name
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First
Last
Date
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Telephone
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Email
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Address
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Where would you like to go?
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Estimated Budget
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$100 - $500 Per Person
$501 - $1000 Per Person
$!001 - $3000 Per Person
$3001 - $5000 Per Person
$5000+ Per person
Do you need a deposit option?
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Yes
No
If paying in full, what date will payment be made?
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If yes, what date will deposit be made?
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How Many Adults
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Do ALL travelers have current Passports?
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Yes
No
Some do
Applied for
How many Children Under Age 18
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Departure Date
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Return Date
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Departure Airport or Port of Call
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Arrival Airport or Port of Call
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Legal Names (Birth dates) of ALL going on the trip:
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Preferred Hotel
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Preferred Cruiseline
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FOR CRUISES Choose ALL that apply
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Pre Pay Gratuities
Inside Cabin
Ocean View Cabin
Balcony Cabin
Suite
Has Client Cruised Before?
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Yes
No
Do you have a VIFP Club Member Number?
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Yes
No
If Yes, Name of Cruiseline and your VIFP Number
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***International Air Travel: Passports are required for all flight travel.
***For Cruises: Verify with cruise line if a passport is required or certified birth certificate is suffice.
Choose ALL that Apply
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Air
Hotel
All Inclusive
Condo
Resort
Vacation Home
Tours
Car Rental
Cruise
Shore Excursions
Special Occasion
Travel Insurance
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Yes
No
*By declining Travel Insurance, I understand that I take full responsibility for any occurrences in my travels to include but not limited to
Trip cancellation/interruption
– which provides reimbursement for unused arrangements should you need to interrupt because of unforeseen illness or injury to yourself, a family member, or traveling companion; jury duty; subpoenaed; hijacked; quarantined; direct involvement in a traffic accident; or having your home made uninhabitable by a natural disaster.
Travel delay
- reimburses additional transportation costs and unused vacation days should your vacation be delayed for 12 hrs or more due to, a delay by your airline; lost or stolen travel documents; hijacking; civil commotion, riot; or a traffic accident en route to departure.
Emergency evacuation/repatriation
- arranges and pre-pays the cost of emergency medical transportation should a serious illness or injury during your vacation require your medical evacuation.
Medical expense
- reimburses medical costs should you incur hospital charges or other medical bills as a result of an illness or injury during your vacation.
Lost/stolen baggage or personal effects
- reimburses you for baggage or items lost, stolen, or damaged during your vacation.
Delayed bags
- reimburses for the purchase of necessary personal items if your bags are delayed by the airline for 24 hours or more.
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