Custom Memories Travel - Initial Questionnaire
Our goal is to customize your travel experience to meet YOUR needs and desires. These questions should be filled in with that in mind...let us get to know you so we can help you better! When possible, please have all members traveling complete this form so that we can make sure everyone will be happy! Thanks and God bless!
First Name
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Last Name
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Preferred Phone Number
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-
Area Code
Phone Number
This number is my:
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Cell
Home
Work
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
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
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
E-mail
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Preferred Contact Method
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Email
Phone
Direct Mail
What is your age range?
*
Please Select
18 or under
19-25
26-35
36-45
46-55
55+
Prefer not to say
Have you used a travel agent in the past?
*
Yes
No
Birthday Month
*
Please Select
January
February
March
April
May
June
July
August
September
October
November
December
Tell us about your favorite past vacation experience!
Which hotel/lodging did you stay in?
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What is your favorite destination you traveled to?
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What three things did you like MOST about your trip?
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What three things did you LEAST like about your trip?
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Tell us about your accommodation preferences:
My favorite hotel chain is:
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My accommodations must be: (check all that apply)
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Suite
King bed
Double bed
Non-Smoking
Smoking
A preferred view
Top floors
My accommodations must have the following amenities: (check all that apply)
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Free breakfast
Free parking
Internet access
Pool
Self-service laundry
Fitness center
On-site restaurant/bar
Pet-friendly
Business center
Tell us about your air travel preferences:
My preferred departure airport is:
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My second airport choice is:
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I prefer to fly:
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Please Select
First Class
Business Class
Coach
I prefer to depart in the :
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Please Select
Early Morning
Late Morning
Afternoon
Evening
Late Evening
Tell us more about your vacation preferences:
How long ago was your last vacation out-of-state?
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If you could travel to any destination in the world, where would it be?
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When my destination is over 4 hours away, I prefer to:
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Fly
Drive my car
Rent a car
Have arranged ground transfers
When I arrive at my destination by air, I prefer to:
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Use public buses/taxis
Rent a car
Have pre-arranged ground transfers
Regarding All-Inclusive Resorts:
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Please Select
I love them! That is my favorite way to vacation!
I have stayed at one and would consider it again.
I have stayed at one and do not prefer this type of vacation.
I have not stayed at one, but it sounds like fun!
I have not stayed at one and do not desire to.
Regarding Cruises:
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Please Select
I love cruising! That is my favorite way to travel!
I have cruised and would consider it again.
I have cruised before, but prefer land vacations.
I have NOT cruised before, but would love to try it!
I have NOT cruised before and do not wish to try.
Of the following, my favorite vacation activity would be to:
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Please Select
Lay on the beach with a cold drink
White water raft down a rapid river
Snorkel at an exotic coral reef
Visit cultural museums
Shop, shop, shop!
Ride a crazy roller coaster
Of the following my favorite vacation activity would be to:
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Please Select
Get a spa manicure/pedicure
Zipline through the jungle
Jet ski around the lake
Tour the historic district
Eat at the finest restaurant in town
Watch a Broadway-style show
If money were no object, my dream vacation would be:
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Tell us about your upcoming travel:
What destinations did you have in mind, if any?
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What dates do you wish to travel between?
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What event are you celebrating?
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What is your PER PERSON travel budget for this trip?
*
Please Select
$1,500-2,000
$2,001-2,500
$2,501-3,000
$3,001-3,500
$3,501-4,000
$4,001-4,500
$4,500-5,000
$5,001-5,500
$5,501-6,000
$6,001-6,500
$6,501-7,000
$7,001-7,500
$7,501-8,000
$8,001-9,000
$9,000-10,000
$10,001-11,000
$11,001-12,000
$12001-13,000
$13,001 - 14,000
$14,001+
I wish the majority of my travel would be:
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Please Select
Relaxation! I need a break!
Adventure! I love the thrill of trying new things!
Sight-Seeing! I love learning about new places!
A combination of all 3!
How many people over age 12 will be traveling?
*
Please Select
1
2
3
4
5
6
7
8
9+
How many children under age 12 will be traveling?
*
Please Select
0
1
2
3
4
5
6
7
8
9+
My itinerary for this trip is:
*
Please Select
Set in stone. Just find me the best deal.
Flexible. I have ideas, but would like to explore my options.
Up in the air! I would love someone to customize my trip!
Regarding Travel Insurance:
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Yes! I understand the importance, I want it!
I would like more information before deciding.
No, thank you. I do not need a refund if I have to cancel.
If possible, I would love to explore the following options:
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Fine Dining
Spa Treatments
Water Excursions
Thrilling Adventures
Theater/Entertainment
Guided Destination Tours
Shopping
Cultural Experiences
Museums
Landmarks
Theme Parks
My desired package for this vacation is:
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Custom All-Inclusive Land Itinerary
Custom All-Inclusive Cruise Itinerary
Custom Land Package
Custom Cruise Package
I'm not sure...help!
Submit
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