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FILL OUT THIS FORM AND E-MAIL TO howard@highseastravel.com
OR PRINT AND FAX TO (540) 377-2243
High Seas Travel Pre-Cruise Questionaire
Date: No. In Party:
First Name: Adults:
Last Name: Children:
Address: Ages:
Daytime Phone #: Any Handicap Requirements?:
Evening Phone #: Any Sea Sickness Problems?:
FAX #: Desired Length of Cruise:
Target Budget Range: Desired Destination:
How Often Do You Vacation?: AREAS OF INTEREST:

East Coast, USA
West Coast, USA
Mississippi / Rivers

Carribbean

Eastern
Western
Southern

Bermuda
Panama Canal
Alaska
East Coast Canada
Mexico
Hawaii
Europe
Europe Rivers
Great Britain
Scandinavia
Baltic Area

Mediterranean

Western
Eastern

Egypt / Nile
Orient
Australia / New Zealand
Indonesia
South Pacific
Indian Ocean
South America
Trans-Atlantic / Pacific
Other
Have You Cruised Before?:
Date Of Cruise:
Ship Name:
Length of Cruise:
Itinerary:
Likes:
Dislikes:
Desired Date of Cruise:
Alternative Dates:

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Call us now at  (540) 377-5335 or (800) 776-7988

Fax (540) 377-2243

Howard Cutson, MCC
High Seas Travel
Raphine, Virginia

Remember...
"You haven't lived until you've cruised!"

1802 Ridge Road
Raphine, VA 24472