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Kelly Cruises Presents

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Contact Information
E-mail Address*
First Name*
Last Name*
Address line 1
Address line 2 (suite, apt., etc.)
City
State (US addresses)
Province (Canadian addresses)
Other address (international)
Postal Code
Day telephone
Evening telephone
Fax

Notification Preferences
Do you wish to receive e-mail notifications regarding travel promotions?*	Yes No
Do you wish to receive e-mail notifications about last minute deals?*	Yes No
Do you wish to receive direct mail?*	Yes No
Would you like to receive our newsletter electronically (through e-mail notification and availability on the web) or direct mail (postal delivery)?*	Electronically Direct Mail

Travel Preferences

Favorite Cruise Lines. Check all that apply:

Destination Preferences. Check all that apply:

*Cruise Tours:*
	Are you interested in land tours combined with a cruise?	Yes No
	Are you interested in customized shore excursions?	Yes No

Previous Booking Information
Have you booked with Kelly Cruises Before?	Yes No
If you have booked before, who was your agent?

*Accommodations. Check all that apply:*
	Single	Double	Triple	Quad
*My preferred length of vacation is:*
	3-4 days	7-9 days	10-14 days	15 days or longer
*My average vacation budget is:*
	up to $1500	$1501-$2500	$2501-$5000	Over $5000