Agency Name Agency Trading Name (if different) Agency Chain/Affiliation Agency Address Agency Email Agency Phone Number Agency Fax Number Store Manager Name Store Manager’s Email No. of years trading How did you hear about us Would you like to receive in store training? Yes, In-store Training Yes, Product Information Night Yes, Webinar No, Thank You If yes, which destinations would you like training on? Fiji Cook Islands Norfolk Island Vanuatu Tahiti Lord Howe Island Samoa New Caledonia Niue Tonga Solomon Islands Pitcairn Island Would you like more information on Special Interest packages? Yes, Diving and Fishing Yes, Special Events Yes, Health & Wellness Yes, Cruising No, Thank You
