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Personal Information Please tell us about yourself. (All fields required unless indicated) Salutation: Select Mr. Mrs. Miss Ms. First Name: Last: Address: City, State: Select Alabama American Samoa Arizona Arkansas Armed Forces Armed Forces Americas Armed Forces Pacific California Colorado Connecticut Delaware Washington D.C. Fed. Sts. of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana ME-Maine MH-Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey NM-New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland North West Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Zip/Postal Code: Country: Select Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Aruba Australia Austria Bahamas Bahrain Bangladesh Barbados Belgium Belize Benin Bermuda Bhutan Bolivia Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Keeling Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Enderbury Islands Equatorial Guinea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Germany Ghana Gibraltar Greece Greenland Grenada Grenadines St Vincent Guadeloupe and Martinique Guam Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kenya Kirbati Korea Dem Peoples Rep Korea Repof Kuwait Lao Peoples Dem Rep Latvia Lebanon Lesotho Liberia Lithuania Luxembourg Macau Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antille New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Lucia Samoa Western San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Islands Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain and Canary Islands Sri Lanka St Helena St Kitts St Pierre and Miquelon Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay US Minor Outlying Islands Vanuatu Venezuela Vietnam Virgin Islands Virgin Islands British Wallis and Futuna Islands Yemen Yugoslavia Zaire Zambia Zimbabwe Citizenship: Date of Birth: (MM/DD/YYYY) Email Address: Phone: Phone (Alt): (optional) Business Information Please tell us about your experince. How many times have you cruised? Select 1-2 Cruises 3-4 Cruises > 5 Cruises  Do you have any travel industry experience? Select No Yes Are you in the cruise business? Select No Yes If you are currently selling cruises, please indicate your last 12-month sales volume: Select $0-20,000 $20,001-50,000 $50,001-90,000 $90,001-150,000 $150,001-250,000 $250,001-400,000 $400,001-700,000 $700,001-1,000,000 $>1,000,000 (optional)  How many hours per week are you able to work? Select 1-5 hours per week 5-10 hours per week 10-15 hours per week 15-20 hours per week 20-25 hours per week 25-30 hours per week 30-35 hours per week 35-40 hours per week >40 hours per week  Work Experience (or paste your resume)  What type of Internet connection do you have? Select Dial Up DSL Cable Modem T1 Satellite Other  Have ever filed for bankruptcy? Select No Yes  How did you learn about CruiseDirector? Product Selection Please select the products you are interested in.  Select a Product: Select Standard Plan Pro Agent Plan Premium Pro Agent Plan

If you have more questions about becoming a member of CruiseDirector for agents, please visit our FAQ page or call us at 888-409-2784