| Personal Information: |
| First Name |
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| Last Name |
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| Street Address |
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| City |
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| State/Province |
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| Zip/Postal Code |
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| Country |
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| Work Phone |
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| Cell Phone |
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| Email |
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Number of persons travelling: |
| Adults |
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| Children |
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Age of the persons travelling: |
| How many age 0-18 |
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| How many age 18-25 |
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| How many age 25-35 |
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| How many age 35-45 |
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| How many age 45-55 |
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| How many age 55-65 |
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| How many age 65+ |
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Destinations we would like to visit: |
| Antarctica: |
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| Argentina: |
| Iguazu Falls |
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| Buenos Aires |
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| Cordoba |
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| Mendoza/Wine Country |
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| Patagonia |
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| NorthWest/Salta |
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| Tierra del Fuego |
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| Puerto Madryn |
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| Other |
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| Bolivia: |
| Uyuni |
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| La Paz |
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| Sucre |
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| Potosi |
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| The Jungle |
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| Other |
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| Brazil: |
| Rio de Janeiro |
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| Iguazu Falls |
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| Salvador de Bahia |
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| Belen |
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| Manaus |
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| Brazilia |
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| The Amazon |
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| The Beaches |
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| Other |
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| Chile: |
| Santiago de Chile |
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| Valparaiso & Vina del Mar |
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| Torres del Paine |
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| Punta Arenas |
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| San Pedro de Atacama |
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| Wine Country |
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| Easter Island |
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| Puerto Montt & Chiloe |
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| Other |
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| Peru: |
| Cuzco & Machu Picchu |
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| Puno & Titicaca |
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| Lima |
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| Amazons |
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| Colca Canyon |
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| Nazca Lines |
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| Arequipa |
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| Other |
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The date we are planning our departure: |
| MM/DD/YY |
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Are you flexible with the dates? |
| Yes |
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| No |
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Length of the trip: |
|
Weeks |
|
Days |
Our budget per person for the entire trip including international flights is: |
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Our preferred accommodation type is: |
| Bed & Breakfast | |
| Estancia/Ranch | |
| Standard *** | |
| First Class **** | |
| Deluxe ***** | |
| Luxury - Boutique Hotels/Resorts | |
We will need the following types of transportation: |
| International Flights | |
| Domestic Flights | |
| Bus | |
| Private Transportation | |
| Car Rental | |
| Train | |
| Ferry/Boat/Cruise | |
The main purpose of our trip is: |
| Family Vacation Trip | |
| Business | |
| Group tour | |
| Adventure | |
| Honeymoon/Anniversary/Romance | |
| Educational/Language/Cultural Immersion | |
| Friend's Getaway | |
| Other | |
We like to participate in the following activities: |
| Hiking/Walking/Trekking | |
| Mountain Biking/ Cycling | |
| Golf | |
| Fishing | |
| Tennis | |
| Horseback Riding | |
| Skiing | |
| Bird watching | |
| Other | |
The level of activity we are interested in: |
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We are also interested in: |
| Local Culture/arts |
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| Food & Wine |
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| Bird Watching |
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| Whale Watching |
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| Language Learning |
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| Museums/Architecture |
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| Other |
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Please list any other "must have" highlights you would like on your trip: |
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Please list any additional information which may be relevant/important to your trip (i.e. dietary/health restrictions, special needs, etc.): |
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