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Direct Phone Number/Cell *

NAME OF HOST AGENCY *

HOST AGENCY BRANCH CITY, STATE (if n/a type n/a) * Please advise your physical location. If there are more than one branch in the same city, please specify the branch details. For travel advisors who are home-based, please fill-in “home office”.

NAME OF IC AGENCY (if n/a type n/a) *

AGENCY WEBSITE (if n/a type n/a) *

ADVISOR LOCATION CITY, STATE *

(What city/state do you reside for meeting/entertaining opportunities when Langham Hospitality Group comes to your city.)

IATA NUMBER * (7 or 8 Digit Numeric Code) of an accredited entity (e.g. 55632578)

I AM PART OF (click all that apply) * Select All Virtuoso Serandipians SELECT Signature None Other

I HAVE BOOKED THESE LANGHAM HOTELS IN THE PAST

MY PERSONAL REVENUE PRODUCTION INTO LANGHAM HOTELS IN LAST 12 MONTHS

I AM INTERESTED IN LEARNING MORE ABOUT THESE HOTELS The Langham Hotels & Resorts Cordis Hotels & Resorts Affiliate Hotels

MY PREFERRED BOOKING METHOD IS *

HOTEL RESERVATIONS TEAM/WEBSITE

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OTHER (please specify)

PSEUDO CITY CODE *

GDS SYSTEM *

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Sabre

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