Travel Agent Registration
Fields marked as (*) are mandatory
Login Name *
Password *
Confirm Password *
Company Name
First Name*
(Legal, Not Nickname)
Middle Initial
Last Name *
Date of Birth*
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JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
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1999
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2002
2003
2004
2005
2006
2007
2008
2009
Street Address *
City *
State *
Country *
USA
CANADA
UK
AUSTRALIA
IRELAND
NEW ZEALAND
AFGHANISTAN
ALBANIA
ALGERIA
ANDORRA
ANGOLA
ANGUILLA
ANTIGUA AND BARBUDA
ARGENTINA
ARMENIA
ARUBA
AUSTRIA
AZERBAIJAN
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA AND HERZEGOVINA
BOTSWANA
BRAZIL
BRITISH VIRGIN ISLANDS
BRUNEI
BULGARIA
BURKINA FASO
BURMA
BURUNDI
CAMBODIA
CAPE VERDE
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHINA
COLOMBIA
COMOROS
CONGO
COSTA RICA
CROATIA
CUBA
CYPRUS
CZECH REPUBLIC
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUINEA
ERITREA
ESTONIA
ETHIOPIA
FED. STATES OF MICRONESIA
FIJI
FINLAND
FRANCE
FRENCH GUIANA
FRENCH POLYNESIA
GABON
GERMANY
GHANA
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUATEMALA
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HONDURAS
HONG KONG
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN
IRAQ
ISRAEL
ITALY
IVORY COAST
JAMAICA
JAPAN
JORDAN
KAZAKSTAN
KENYA
KIRIBATI
KUWAIT
KYRGYZSTAN
LAOS
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAU
MACEDONIA
MADAGASCAR
MALAWI
MALAYSIA
MALI
MALTA
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MAYOTTE
MEXICO
MOLDOVA
MONACO
MONGOLIA
MONTESERRAT
MOROCCO
MOZAMBIQUE
NAMIBIA
NAURU
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NICARAGUA
NIGER
NIGERIA
NORTH KOREA
NORWAY
OMAN
PAKISTAN
PALAU
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
POLAND
PORTUGAL
QATAR
REPUBLIC OF GEORGIA
REUNION
ROMANIA
RUSSIA
RWANDA
SAINT HELENA
SAINT KITTS AND NEVIS
SAINT LUCIA
SAINT VINCENT & THE GREN.
SAN MARINO
SAO TOME AND PRINCIPE
SAUDI ARABIA
SENEGAL
SERBIA AND MONTENEGRO
SEYCHELLES
SIERRA LEONE
SINGAPORE
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH KOREA
SPAIN
SRI LANKA
SUDAN
SURINAME
SWAZILAND
SWEDEN
SWITZERLAND
SYRIA
TAIWAN
TAJIKISTAN
TANZANIA
THAILAND
THE BAHAMAS
THE GAMBIA
TOGO
TONGA
TRINIDAD AND TOBAGO
TUNISIA
TURKEY
TURKMENISTAN
TURKS AND CAICOS ISLANDS
TUVALU
UGANDA
UKRAINE
UNITED ARAB EMIRATES
URUGUAY
UZBEKISTAN
VANUATU
VATICAN CITY
VENEZUELA
VIETNAM
WALLIS AND FUTUNA
WESTERN SAHARA
WESTERN SAMOA
YEMEN
ZAIRE
ZAMBIA
ZIMBABWE
Zip/Postal Code *
(Note: Mandatory numeric for
USA, Alphanumeric for Canada)
Major Metro Area *
SELECT MajorAreaID,MajorAreaName From tbl_majorarea Where tbl_majorarea.Active=Yes Order By MajorAreaName
Albury NSW (AU)
Atlanta
Auckland (NZ)
Boston
Brisbane (AU)
Buenos Aires (ARG)
Cairns (AU)
Canberra (AU)
Charlotte
CHENNAI (IN)
Chicago
Christchurch (NZ)
Cincinnati
Cleveland
Columbus (OH)
Dallas / Ft Worth
Denver
Fort Myers/Naples
Gold Coast (AU)
Houston
Indianapolis
Istanbul (TU)
Kansas City
Las Vegas
Los Angeles
Melbourne (AU)
Memphis
Miami / Fort Lauderdale
Minneapolis
Montreal (CA)
Muscat (OMAN)
Nashville
NEW DEHLI (IN)
New York
Norfolk (VA)
Omaha
Other
Palm Springs
Paris (FR)
Perth (AU)
Philadephia / Wilmington
Phoenix
Portland (OR)
Raleigh/Durham/Chapel Hill
Rochester (NY)
San Diego / La Jolla
San Francisco
Seattle
Sofia (BU)
St Louis
Sunshine Coast (AU)
Sydney (AU)
Syracuse (NY)
Tampa / St Pete / Sarasota
Tel Aviv / Jerusalem / Haifa
Toronto (CA)
Tucson
Vancouver BC (CA)
Washington DC
Wellington (NZ)
Winnipeg (CA)
Zurich (CH)
Telephone *
Fax
Email *
How do you hear about us ?*
CLIA Number
IATA Number
Seller of Travel License #
State/Country
Website
http://
What type of Travel Agency are you (check one) ? *
Retail Shop
Online Only
Home Based
Which networks / industry groups do you belong to ? (check all that apply)
AMEX
Virtuoso
Signature Travel Network
Ensemble
ASTA
CLIA
OSSN
IGLTA
AFTA (AU)
Cediv (F)
Manor (F)
I hereby acknowledge that I have read and accept the Distribution Agreement (Electronic signature is accepted as legally binding).
I wish to be listed on the EuroPanache website as an Accredited and Licensed Travel Agent
Download Distribution Agreement (USA)
Download Distribution Agreement (Australia)