Title/Rank (optional)
First Name*:
Last Name*:
Address*:
City*:
State*:		Zip*::
E-mail Address*:
Phone Number*:
If you have a preferred consultant, please enter their name:
Are you a member of:	NMFA (National Military Family Association)

Which destinations do you plan to travel to in the next 3 years?
	Africa & the Middle East		Hawaii
	Alaska & Canadian Rockies		Mediterranean
	Asia & Orient		Mexico
	Australia, New Zealand & South Pacific		Panama Canal & Latin America
	Caribbean & Bahamas		South America & Antartica
	Disney		TransAtlantic
	Europe		USA, Canada & Bermuda

My next vacation, not currently under deposit will be:
Can you travel on relatively short notice, less than 2 or 3 months, as specials become available?
Yes	No

General Travel		Group Travel
	I would be interested in cruising by myself, as a single.		Please notify me of group cruises or tours
	I am interested in senior citizen programs		I am especially interested in escorted groups
	I am interested in children's programs, discounts		I am a group leader

	I am interested in health & fitness travel	Please list any special interest group you would be interested in
I have been on the following cruise lines:
I have traveled with the following tour companies:

If you would like to make a special request, please type it in the area below and hit send when you are done. Thank you for using Brennco.

		By completing the information below, you will be notified as special offers become available that meet your individual traveler preferences. PLUS, as an added bonus, you will receive a FREE subscription to our Destinations Newsletter. Required fields have an asterisk(*)