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BOOKING REQUEST

Names of Travellers (full first name and last name as it appears on the passport) * if passenger is a child, please specify age.
Contact Name:
Phone - Work:
Phone - Home:
Phone - Mobile:
Fax:
Email:
Street Address:
City:
State:
Zip:

Trip Info:
City of Origin:
Preferred Departure Date:
Preferred Return Date:
Alternate Departure Date:
Alternate Return Date:
Total # of Days:

Special Interests & Activities:
First Choice:
Second Choice:
Third Choice:

Hotel Prefences for your Destination:
Fiji Islands:
Hawaii:

Additional Information:
Special Requests:



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Island Marketing Group
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714-840-1902 - fax
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