LIVE FOR TODAY TRAVEL INQUIRY FORM

GENERAL TRAVEL INQUIRY FORM

Thank you so much for reaching out to me! My services come at no extra cost to you! I will work hard to get you the best price available for your upcoming travel. Please fill out this form in it's entirety so I can better assist you. I will be in touch within 1 to 2 business days. Please add mylene@livefortodaytravel.ca to your safe-sender list to prevent any email correspondence from going to your junk/spam folder.
MYLENE BROEKEMA

TRAVEL AGENT
Name*

First NameLast Name
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Preferred Method of Contact - Check all that apply.*

EmailPhone CallText Message
U.S. Military Involvement?*

NoNo but someone traveling with me isYes I am Active DutyYes I am RetiredYes I am a Military SpouseOther
Travel Information
Where would you like to go*
Departure Airport*
If not flying, put Driving from (city)
Travel Start Date*
Month/Day/Year
Travel End Date*
Month/Day/Year
Are your travel dates flexible?

YesNo
How many travelers age 18+*
Based on Travel Start Date
How many travelers age 10-17*
Based on Travel Start Date
How many travelers age 3-9*
Based on Travel Start Date
How many travelers age 2 or Under*
Based on Travel Start Date
If there are multiple families/couples traveling, how would you all like to be split into rooms? If anyone is military, please indicate which room they will be in!
Example: Room One = 2 adults & 5 year old, Room Two (military) = 1 adult & 8 year old, or We prefer a large suite that will sleep everyone, etc.
What is your maximum budget per person?*

$10,000+Other
What kind of Vibe are you looking for? Check All that Apply.*

Kid/Family FriendlyCulture/CulinaryAdventure/ActiveOff the Beaten PathRomanceRest & RelaxationNightlife/PartyHealth & WellnessClothing OptionalAdult Only SinglesAdult Only CouplesOther
Type of Travel? Check All that Apply.*

Family VacationWeddingSolo TravelHoneymoonBusiness TravelGirl's TripGroup TravelGuy's TripCouple's GetawayAll InclusiveCruiseDIsney VacationUniversal PackageFlight and hotel packageOther
Any Celebrations?

BirthdayAnniversaryGraduationOther
Anything you absolutely must see or do?
Example: Magic Kingdom, The Eiffel Tower, Snorkeling, Swim with Dolphins, Zip line, etc.
Any other Requests, Preferences, or Information you want me to know?
Example: We prefer to fly first class on Delta, ocean views, and a king size bed, etc.
Please verify that you are a human.*
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GENERAL TRAVEL INQUIRY FORM

MYLENE BROEKEMA

Travel Information