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New User Profile

Click 'submit' when you have completed this form. 
( * required answers;    # additionally required items in order to process State of Colorado business)
 
Sign on Name * (must be at least 6 characters)
Sign on Password * (must be at least 6 characters)
Password Repeated * (must match first password)
Your Email Address *
You will be prompted with the following Security Question if you happen to forget your password and request that it be emailed to you.  Suggested security questions are: What was your maiden name?, What is your favorite color?, What was your first pets name?, etc.
Your Security Question *
Your Security Answer * (the answer to the security question above.)  
Agency Name *
Agency Address *
Agency City * State Zip
Agent Name *
Agency Phone * * Fax
Your Web Site  
(for example: http://www.mywebsite.com
If you don't have a Web site, just leave this blank.)
Home Address *
Home City * State Zip
Home Phone * (for internal use only)
Cell Phone   (for internal use only)
Toll Free Phone # Office
Start Date as Agent # (Date you started in Travel Industry.)
References
# 1st Name Phone
  Company   Address  
# 2nd Name Phone
  Company   Address  
# 3rd Name Phone
  Company   Address  
# Brief Work Experience
Your Product Specialties Your Destination Specialties
1st 1st
2nd 2nd
3rd 3rd
4th 4th
5th 5th
6th 6th
Note: You must provide at least one Product and one Destination specialty if you want to receive client referrals on the "Find an Agent" page.