TRAVELER REGISTRATION FORM

Complete One Form For Each Traveler

Trip name

First name

IF YOU USE A PREFERRED NAME, please provide for your nametag

Last name

Full name (EXACTLY as it is written on your passport)

Date of birth * required

Gender (as written on passport) *

Male

Female

Passport number

Passport issue date

Passport expiration date

Email (This is our primary method of communication)

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Are you traveling with a spouse or friend as a roommate? *

Yes

If YES, provide the name of your roommate here

If you are traveling alone, are you willing to be paired with another single traveler of the same gender to share a room?

Yes

No, I want a single room

Do you have any medical conditions we need to be aware of? If yes, please explain.

Do you need any special accommodations due to a medical or physical need? If yes, please explain.

I understand that the purchase of travel insurance is REQUIRED to protect my financial investment and if I choose NOT to purchase travel insurance coverage, TP4U will not be responsible for loss incurred outside of the parameters identified in the Terms and Conditions on this website. *

Yes: I agree to purchase travel insurance.

No: I waive the purchase of travel insurance.

Sign below to confirm your selection to waive the purchase of travel insurance.

I have read and agree to the Terms and Conditions.View Terms and Conditions

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CONNECT WITH US

Patricia Stirnkorb, CTA

pat@travelplanners4u.com

513-910-0510

Jackie Lee, CTA

jackie@travelplanners4u.com

513-266-0272

TELL US WHERE YOU WANT TO TRAVEL

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