416 9th Street Plaza Huntington 25701 (304)523-3627 1-800-647-3627 Fax (304)5256543
TRAVEL DOCTORS TRAVEL CLUB
Membership Information
First Name: _____________________ Spouse Name: _________________
Last Name: ______________________ Middle Initial:_______________
Street Address: ________________________________________________
City, State, Zip: ______________________________________________
Employment: ____________________________________________________
Work Number: (____)__________
Home Number: (____)__________
Fax Number: (____) __________
E-Mail Address: _____________________
Would you be interested in group travel? ___Yes ____No
If Yes, who do you think would be interested in traveling with you?
Name Address Telephone
_______________________ _______________________ ______________
_______________________ _______________________ ______________
_______________________ _______________________ ______________
_______________________ _______________________ ______________
_______________________ _______________________ ______________
_______________________ _______________________ ______________
Kindly complete the following travel information. Please check if interested.
___Domestic Travel ___Bed and Breakfast ___Bus Tours ___Golf Package
___Gambling Getaway ___Fly/Drive Tours ___Diving/Water sports ___European Tours
___Resort/All Inclusive ____Other _____________________________________________
___Cruises ______________________________________________
___Caribbean
___Alaska
___Europe
___Bermuda
Return this membership form with your fee to
Travel Doctors, Attn: Bill Fish
416 9th Street Plaza
Huntington, WV 25701
a full service Travel Agency