Pre Trip Questionnaire

Booking Agent (*)

Lodges of interest (*)

Category

Personal Information

First Name(*) (as it appears on your passport):

Last Name(*) (as it appears on your passport):

Preferred Name

Passport Number(*)

Expiration Date(*)

Birth Date (*)

Contact Information

Phone

Email(*)

Address(*)

City(*)

State(*)

Country(*)

Zip Code(*)

Others

Do you have medical conditions or a dietary restriction?

Do you have any allergies ?

Any special request?

Favorite drink(s)?

Emergency Contact

Name(*):

Relationship:

Phone(*):

International Flights

Arrival Date:

Time:

Flight Number:

Company:

Arrival Airport:

Departure Date:

Time:

Flight Number:

Company:

Departure Airport:

Domestic Flights

Arrival Date:

Time:

Flight Number:

Company:

Arrival Airport:

Departure Date:

Time:

Flight Number:

Company:

Departure Airport:

*Please answer the above security question so we know we are being contacted by a real person.