Travel Client Registration Form

Today's Date

MonthDayYear

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Phone Number*

Area CodePhone Number

Alternate Phone Number

Area CodePhone Number

Add Pre-Paid Gratuities? $12/per person per day ($48/per person total)

YESNO

Dining Request

For Booking Purposes, Please include Full Names, Birthdates & Passport Information (if available) for each guest.

NAME/TRAVELER #1*

Date of Birth #1*

MonthDayYear

Emergency Contact Name & Number

PAST GUEST # (if applicable)

Decline Travel Insurance - Automatically included unless otherwise stated here.*

YESNO

NAME/TRAVELER #2

Date of Birth #2

MonthDayYear

Emergency Contact Name & Number

PAST GUEST # (if applicable)

Decline Travel Insurance - Automatically included unless otherwise stated here.

YESNO

NAME/TRAVELER #3

Date of Birth #3

MonthDayYear

Emergency Contact Name & Number

PAST GUEST # (if applicable)

Decline Travel Insurance - Automatically included unless otherwise stated here.

YESNO

NAME/TRAVELER #4

Date of Birth #4

MonthDayYear

Emergency Contact Name & Number

PAST GUEST # (if applicable)

Decline Travel Insurance - Automatically included unless otherwise stated here.

YESNO

Special Needs Requirements*

YesNo

Please Specify (if Applicable)

Notes/ Comments

Option 1Option 2Option 3

PFLAG HERNANDO • CLIENT PROFILE / REGISTRATION

TRAVELER(S) INFORMATION

Additional Information