Passenger Information Form

PASSENGER INFORMATION FORM

First Name

Last Name

Phone

Multi-line address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Date of Birth

Gender

Passport Number

Issue Date

Expire Date

Are you a US Citizens

Emergency Contact - Full Name

Emergency Contact's Phone

Emergency Contact's Email

Do you take any medication we should know about?

Only required if you take prescription medication. In the event something is wrong with you, we will know to inform medical authorities that you do.

Do you have any food allergies?,

Example- I am allergic to eggs.

Will you be purchasing Travel Insurance?

Yes, I will purchase Travel Insurance and provide proof

No, I am willing to take the risk and lost my investment

Please provide a quote

Other

AGREEMENTS & DISCLOSURES

Charge Backs*

I agree that I will not engage in any attempts to pursue any charge-backs with my credit card company if my travel plans change

Acknowledgement of Information Provided *

All names and dates of birth listed above are as they appear on your passport. I understand that if I have provided incorrect information that I may be denied boarding without compensation.

POLICIES

I accept Terms & Conditions

I accept the Refund Policy

ELECTRONIC SIGNATURE AGREEMENT

Electronic Signature *

I agree that submitting this form is the legal equivalent of my manual signature.

Signature

Signature field is empty.

Travel Explore & Repeat The Exotic Way

PASSENGER INFORMATION FORM