Travel Request Form

My husband and I have enjoyed many years of travel, creating lasting memories. I would be very pleased to do the same for you. Thank you for considering me for your travel services.

My services do not only include planning the trip but also supporting you as you prepare for the trip, I am your personal concierge and problem solver as you travel (this avoids YOU losing valuable vacation time) and I can even help after travel if there is any follow-up needed).

Michele Karnes, Ed.D., MS, OTR, Travel Planner, Accessible Travel Concierge
Travel Request Form

Please provide as much information as possible to assist with your personalized trip planning. Feel free to drop questions in the Additional Comments field.
Name*

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Travel Details:
Purpose of Travel:
Destination(s): (please let me know if you need ideas!)
Departure Date:

MonthDayYear
Date
Return Date:

MonthDayYear
Date
Flexible:

YESNO
Number of Adult Travelers
Number of those who will be 18 Years or Younger (please provide ages):
Number of hotel rooms or bedrooms needed
Accommodations Requested (click al that apply)

Hotel accomodationShort Term Rental (vacation home type stay)Cruise ShipTour/ExperiencesOther
Do you need car rental?
Please indicate any details for travel or indicate any special travel needs (wheelchair, walker, sensory, diet, other). This will be confidential but information will be used to customize your trip so you can enjoy it!
In order to schedule a consultation after submitting this form, please provide best number to call or text and times that are best to reach you.
Method of contact:

Text or callText onlyCall only
Preferred time to text/call (indicate eastern, central or pacific US time)
Signature
Should be Empty:

Travel Request Form

Travel Details: