Information Request Form

Vacation Type:

Please Select Independent Vacation Escorted Tour Module or Stopover Package Other (please decribe)

Tour Name:

Tour Code (if applicable):

Hotel Standard:

Please Select Quality Superior Deluxe Super Deluxe

Room Type:

Please Select Single Twin Double Triple Quad

Is this your first trip to the South Pacific?:

yes no

What countries would you like to visit this trip?

Description/Comments:

Departure City:

Preferred Departure Date:

Select Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2006 2007 2008

Preferred Return Date:

Select Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2006 2007 2008

Passenger Information

Name(s) (as it appears in your passport):

Age:

Please Select: under 18 18-25 26-35 36-45 46-55 56 and over

Number of Adults:

Number of Children:

Ages of Children:

N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Travel Budget per Person:

Please Select: up to $1000 $1000 - $2000 $2001 - $3000 $3001 - $4000 $4001 - $5000 $5001+

First Name

*

Last Name

*

Address 1

*

Address 2

City

*

State

*

Zip Code

*

Home Phone

*

Work Phone

Fax Number

Email

*

I would like to receive information about ANZGS Special Offers

 (Please note: Your personal information will remain confidential at all times and will only be used to update you on our products and services. We respect your privacy) 

Please contact me by:

Please Select phone fax email

Best time to call:

If you have a Preferred Travel Agency, please complete the following:

Travel Agency:

Name of Travel Agent:

Travel Agent Phone Number:

Travel Agent Email:

Comments/Questions