Travel Intake Form

1
Name* This field is required.This information is need for the booking process.
Prefix
First Name
Middle Name
Last Name
2
Address* This field is required.This information will assist us with the booking process.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
3
Email* This field is required.This is the email we will use to contact you.
example@example.com
4
Phone Number* This field is required.This is the phone number we will use to contact you
Area Code
Phone Number
5
Date of Birth* This field is required.This information will be used for booking purposes.
Date
Year
Month
Day
6
Select Trip Type:* This field is required.Please select the type of trip you are interested in booking.
Mystery Trip
You Pick I Plan
Ready to Go
Operation Staycation
Booking Assistance
7
Select Tier* This field is required.Please choose the option that best fits your maximum budget with all travelers
Stardust Explorer ($800 -$2,000)
Stardust Dreamer ($2,500 - $6,000)
Stardust Odyssey ($6,500 - $10,000+)
8
Choose Mode of Transport* This field is required.This is the main mode of transportation that will take you to or from your destination.
Airplane
Cruise
9
Travel dates* This field is required.Start Date
Date
Year
Month
Day
10
Travel dates* This field is required.End Date
Date
Year
Month
Day
11
Are these dates flexible or fixed?* This field is required.Please select the option that best describes your upcoming trip.
Flexible
Fixed
12
Are there any time restrictions or special considerations we should be aware of?If you select yes please explain in the next box
YESNO
13
If you answered “Yes” to having time restrictions or special considerations we should be aware of please explain.Please explain so we can understand and assist you further with your needs.
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14
When you travel, what do you prioritize?* This field is required.Select all that 3-5
Comfort
Cost
Adventure
Relaxation
Wellness
Activities
Cuisine
Cultural Experience
Luxury
Photo Opportunities
Romantic Experience
Family Friendly
Adult only
Accessibility
Museums/ Art Enthusiasts
15
Are there any must-do activities or bucket list activities you would like to do?* This field is required.Select all 3-5
Scuba diving
Safari
Hiking
Bungee Jumping
Jet skiing
Skiing
Surfing
Mountain Climbing
White water rafting
exploring a cave
Food Adventure
Wellness retreat
Concert
Sporting Event
Expedition
Museum or Art Gallery
Other
16
Are there any activities that aren’t on the list, that you really want to do?Please help us make this experience unique for you.
17
Do you have a passport or plan to utilize a passport for this trip?* This field is required.
YESNO
18
If you plan to use a passport, is it valid for at least 6 months after your trip?This is important if you intend to visit certain countries.
YESNO
19
Preferred Airports or Ports* This field is required.Please provide a few of your preferred airports or cruise ports. If you live near a small airport please provide that airport’s name and the nearest large airport near you.
20
Travel Companions * This field is required.Please include the full names and ages (ages at time of departure) for all travel companions traveling on this booking. I.e traveling on the same flight, cruise or the same hotel reservation.
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Dietary restrictions or preferences Please list any dietary restrictions, preferences or allergies we should be aware of.
22
Accommodation Preferences* This field is required.What types of accommodations are you ok with staying in?
Hotels 3-5 star
Resorts 3-5 star
All-inclusives 3-5 star
Villas
Vacation Homes
Hostels 3-5 stars
Inns / Bed & Breakfasts
Lodge/ cabin
Other
23
Do you have any travel preferences?Eg. airlines, cruise lines, hotels, resorts, rental car companies etc.
24
Activities to avoid * This field is required.Are there any activities you would like to avoid during your trip?
25
Special request or considerations(Accessibility, mobility requirements, language preferences or
26
Mystery trip: Destinations to avoid* This field is required.Do you have any destinations that you absolutely want to avoid?
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Mystery Trip: Bucket List Destinations * This field is required.Are there any destinations you really want to visit? List 3-5 destinations below.
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Is there anything else we need to know?Eg. Reservations, flights, regional travel interest, upcoming trips, previous trips
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29
Mystery Trip: Hometown Assumptions * This field is required.List places you’ve lived, visited often, went to school, worked
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30
Choose a region you would like to visit.Please select the one you’re most interested in
USA, Canada & Mexico
Caribbean & South America
Europe
Africa
Asia
Australia, New Zealand & Pacific Islands
31
What type of experience are you looking for* This field is required.Select 1-3
Wellness & Relaxation
Active & Outdoor
Food Adventure
Cultural Immersion
Tropical escape
Winter wonderland
Other
32
Mystery Trip: Preferences* This field is required.Select one of the following
Air Travel
Cruise
Staycation
Surprise Me
33
Describe your ideal vacation in one word.Ex. Magical
34
Schedule a Consultation This consultation will help us better understand exactly what you want.
35
How should we send your proposal?* This field is required.Select the best option for you.
Email
Text
36
Thank you so much for you inquiry. You will receive your proposal in 48-72 hours via email or a link in your text messages.
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