*First Name:

*Last Name:

*Male/Female:

M F

*Mailing Address:

*City:

*State/Province:

None Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming

*Country

United States Argentina Australia Austria Belize Belgium Brazil Canada Chile China Costa Rica Czech Republic Denmark Ecuador Europe Finland France Germany Greece Hong Kong Hungary India Indonesia Ireland Israel Italy Japan Jordan Luxembourg Malaysia Mexico New Zealand Netherlands Norway Peru Philippines Poland Portugal Republic of Singapore Saudi Arabia South Africa Spain Sweden Switzerland Taiwan Thailand Turkey UK

*Zip/ Postal Code:

Phone:

Fax:

Email:

*No. of persons:

0 1 2 3 4+ Adults 0 1 2 3 4+ Children

For the following dates:

FROM M/D/Y

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TO M/D/Y

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Locations:

FIRST CHOICE: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. SECOND CHOICE: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.

1. Nord - Pas-de-Calais 2. Picardy 3. Centre - Val-de-Loire 4. Auverge 5. Limousin 6. Midi-Pyrenees 7. Aquitaine 8. Poitou - Charentes 9. Western Loire 10. Brittany 11. Normandy 12. Champage - Ardenne 13. Lorraine - Vosges - Alsace 14. Burgundy 15. Franche-Comte 16. Rhone-Alps 17. Provence - Cote D'Azur 18. Languedoc - Roussillon 19. Corsica 20. Paris Region

Classification:

Simple accommodation, with garden

Extra facilities including television, washing machine and kitchen appliances

Independent access with private garden, dishwasher, colour television and second bathroom

Character cottage, with interior furnishing of a high standard, fireplace, microwave, fridge/freezer

Facilities required:

Bed 1 Bed 2 Bed 3 Bed 4+ No. of bedrooms

Hideabed Single Double Queen+ Type of bedrooms

Sq.Mtr.

Washing machine

Dishwasher

Microwave

TV

Fireplace

Bed Linen

Distance from:

Swimming

Forest

Fishing

Walking Trails

Tennis

Horseback Riding

Vineyard

Shops

Tourist Sites

Stations

If you haven't traveled with Traveller's Tale before, how did you hear about Traveller's Tale?
Other, (not listed below) Newspaper Website From a friend

If other, please specify:

I plan to take an active vacation in the next:
6 months 7-12 months 1-2 years More than 2 years Not planning to take an active vacation

I have taken this many active vacations organized by a travel company in the last 3 years:
0 1-2 3-5 6+

Yes, I'm interested in receiving periodic Traveller's Tale news and updates by email.